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#279114 - 09/28/17 02:00 AM Re: Pain Contracts? [Re: WhiteCell]  
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This has been a subject I have been very concerned about for many years.

I've been getting extended-release morphine prescribed by the same rheumatologist for about 10 years now. I initially worked with pain management doctors to figure out which pain med and dose worked best. Once we got that figured out and I was on a stable dose, my rheumie took over prescribing.

Due to the increased scrutiny placed on doctors for prescribing these, he eventually required a pain contract. And then, a year or two after that, the UAs started. That was despite the fact that I had been seeing him since 1999 and we have an excellent relationship. The pain contract had nothing to do with his relationship or ability to trust me personally.

He has told me candidly that he does not agree with the opioid prescribing limits. He does not want to give his patients UAs. But he cannot afford for his practice to be affected if he chose to disregard the new climate around pain medications.

At my most recent visit, he told me about a case that happened in 2010 I believe when a doctor was actually prosecuted for not prescribing ENOUGH pain medication to adequately treat a patient's pain. I believe this was is Oregon. Maybe I will ask him for a reference to it next time I see him.

The point is that gradually over the past five or so years, the pendulum has swung completely against genuine pain patients who need these medications. The media is now bombarding the general public with full-blown hysteria about the issue, and its getting worse with each passing year.

There was a rare doctor who was willing to speak to the issue of how chronic pain patients are being affected by this hysteria- here is the segment on NPR from last year: http://www.wbur.org/hereandnow/2016/02/16/underprescribing-opioids-for-pain

For those interested in the origins of this hysteria, there is an investigative reporter who published a series of three in-depth articles several years ago. They are quite good. I will post them in order:

http://www.huffingtonpost.com/radley-balko/prescription-painkillers_b_1240722.html?

http://www.huffingtonpost.com/radley-balko/us-painkillers-abuse_b_1263565.html

http://www.huffingtonpost.com/radley-balko/painkiller-access-debated_b_1332511.html

I truly feel very badly for people who are new to chronic pain at this point. The majority of them are not going to get access to the types of pain medications that were available to me in the early 2000's when I was first in need of them.

One of the sad parts about this is that its very easy for the average person on the street to believe all this hysteria that anyone who takes a pain medication is doomed to become a heroin addict and then overdose. But one day they might slip and fall at work, or get in a car accident, and then they are going to be the one who needs on-going pain management. And then they are going to see what all of the legitimate chronic pain patients have been going through.

#279115 - 09/28/17 02:36 AM Re: Pain Contracts? [Re: WhiteCell]  
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WhiteCell Online
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Thank you very much for posting your experience.

I have not heard back from the ACLU. They're pretty busy these days. I am going to see if the local Seattle Times is interested, or if I feel very strongly I may file a pro per lawsuit in Superior Court.

The policies are creating more problems than they hope to solve in my opinion.


Starting at 18 yrs old > Reiter's Syndrome. Diagnosed 2001 Ank Spon.
Started Remicade 2002 - 5mg/kg every 7 weeks.

Right Eye Glaucoma- Trabeculectomy/lens replacement 2006.
DSEK Cornea Transplant 2009.
Ahmed Shunt 2016.
DSEK Cornea Transplant 2016.
Supra Ventricular Tachycardia. 2004. Cured by RF ablation 2008.

ICU RN - Seattle, WA

~Grasp The Challenge and Succeed~
#279116 - 09/28/17 04:12 AM Re: Pain Contracts? [Re: WhiteCell]  
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This is one of the rare articles I have seen from a major news source that focuses on the effect this war on pain meds is having on legitimate pain patients. It also talks about the issue of pain contracts.

http://www.bostonglobe.com/metro/2016/06/18/the-other-side-america-war-opioids/i9YYLR0bGWFdP9z1T1pwjI/story.html?s_campaign=bostonglobe%3Asocialflow%3Atwitter

#279123 - 09/29/17 12:41 AM Re: Pain Contracts? [Re: WhiteCell]  
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WhiteCell Online
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Pain contracts enforced by force of law are neither pain control or contracts. They are a false premise based upon suspicion and mistrust. I appreciate the articles you posted. I'm going to write to the Huffington Post reporter.

It's likely that this will take years of advocacy to object to intrusive searches and seizures. The best position is to be aware of your pain, timing dosing and what worked when and how it worked. If you have a doctor who insists upon a pain contract and if you wish you an provide this article to them. I believe the best plan is to suggest an immediate removal of the mandatory test as was successfully done in this case in Indiana.

http://www.aclu-in.org/issues/justice/dr...in-med-patients

When you are honest, it's laughable that anyone would ask you to participate in a system which is overfilled with fear, power and control. Those are just circumstances.

Be free.

Last edited by WhiteCell; 09/29/17 02:59 AM.

Starting at 18 yrs old > Reiter's Syndrome. Diagnosed 2001 Ank Spon.
Started Remicade 2002 - 5mg/kg every 7 weeks.

Right Eye Glaucoma- Trabeculectomy/lens replacement 2006.
DSEK Cornea Transplant 2009.
Ahmed Shunt 2016.
DSEK Cornea Transplant 2016.
Supra Ventricular Tachycardia. 2004. Cured by RF ablation 2008.

ICU RN - Seattle, WA

~Grasp The Challenge and Succeed~
#279126 - 09/29/17 09:00 AM Re: Pain Contracts? [Re: WhiteCell]  
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I was actually chuckling when I left the office at how outrageous the "contract' is. PhenQ

Last edited by Sindy; 09/29/17 09:00 AM.
#279273 - 10/13/17 02:17 PM Re: Pain Contracts? [Re: WhiteCell]  
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Unfortunately these drug contracts are becoming the norm,and doctors in general will not prescribe long term pain meds without them. My Rheumatologist is a very caring and compassionate person with whom I have a great relationship. I still was required to sign a contract, no urine tests though. It's pretty much a cover your butt for them, and shouldn't be taken personally.


Diagnosed with AS November 2013,HLAb27-neg. Also diagnosed with Fibromyalga and CREST syndrome. Degenerative disease of the cervical spine.
#279282 - 10/14/17 01:32 PM Re: Pain Contracts? [Re: WhiteCell]  
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WhiteCell Online
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The ironic thing is that contracts create a reality where patients will contemplate other and unlawful ways to obtain drugs in order to avoid the contract. The good news is that several states have dropped the intrusive search requirement. For myself I have adjusted to not having the norco and since the Remicade works well for me, I don't require it but some times it is good to have on hand when it does flare up.

I am contemplating my next move since the ACLU in Seattle is unable to assist. I wish I had the means to challenge it in superior court here pro per I would do so. I formerly served on a Board in California and recruited attorneys to volunteer so I may go that route. It is unequivocally counter productive to test good and decent people in pain. How a medical panel could come up with this aberration is simply stunning to me. It's a challenge to each of us, who honestly require pain control. I may start an on line petition and if so I will post a link here. It will of course and necessarily be anonymous to protect the innocent. I can see how some doctors would really be in conflict about this as well. This is what happens when law enforcement attempts to drive policy on medicine. Everyone looks like a nail.


Starting at 18 yrs old > Reiter's Syndrome. Diagnosed 2001 Ank Spon.
Started Remicade 2002 - 5mg/kg every 7 weeks.

Right Eye Glaucoma- Trabeculectomy/lens replacement 2006.
DSEK Cornea Transplant 2009.
Ahmed Shunt 2016.
DSEK Cornea Transplant 2016.
Supra Ventricular Tachycardia. 2004. Cured by RF ablation 2008.

ICU RN - Seattle, WA

~Grasp The Challenge and Succeed~
#279295 - 10/16/17 10:17 PM Re: Pain Contracts? [Re: WhiteCell]  
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Cake Offline
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Madison, Wisconsin, USA
Here is an excellent article for anyone who is concerned about this problem of the opioid hysteria.

https://www.acsh.org/news/2017/10/12/opioid-epidemic-6-charts-designed-deceive-you-11935

For anyone who has been paying attention over the past few years (mostly people who've needed pain medication during that time), you will know this goes far beyond pain contracts. Insurance companies and pharmacies are placing restrictions on opioid prescriptions, and various states are also enacting laws about how doctors prescribe these medications.

#279297 - 10/17/17 12:25 AM Re: Pain Contracts? [Re: WhiteCell]  
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Sean O Online
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Male, early 50s, Dx AS+ 1991, HLA B27+, Tylenol 3 PRN for flares. Off NSAIDs due to stomach issues. Considering a biologic. SI and thoracic involvement and costochondritis. Many bouts of uveitis. Small bowel issues, anemia.
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