organized curiosity

Improving health care through research

Chronic pain patients shunned by family doctors?

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Chronic pain patients shunned by family doctors?

Note from a patient sent to the blog:

“It is hard enough to find a physician who is willing to take you on as a new patient. Finally, I found one but when I met with him I was told “I am willing to see you if you are off the narcotics.”  He was too scared because I am on a high dose of narcotics for my chronic pain.

When someone is in chronic pain it is hard enough to function let alone have a major stress like this hanging over you. I need a GP to fill in LTD pension forms every year and if I don’t have one then chances are I will also lose my only means of income. As of the beginning of September, unless I have a GP, I have no more access to all the medications I take including insulin, thyroid med, nerve pain med, fluid and BP meds.

I went to the pain clinic and tried all of the treatments. Nothing helped. So, I was put on narcotic pain medication for some quality to life in the late ’90s. I have been managing quite well since then until this problem.  The doctors refuse to write the prescriptions we need because they are too afraid of being investigated, or that was the excuse anyway.

So where does that leave me? Dying from severe sudden withdrawal of all my medications, thanks to the hands of the so called medical system of which I used to be part of. Yes, I used to be an RN, but look at me now and how the system is taking care of me.”  

Comment by Dr. McGrath:

The use of opioid (the medical term for narcotics) pain relievers for chronic pain that cannot be managed by other methods is well established. Although the research could be better, because there are not many long term studies, it is clear that some patients with chronic pain can have their lives dramatically improved by opioids.

There are problems with misuse of prescription opioids. Sometimes, they are not properly prescribed, properly stored or they are sold or given to friends. The inappropriate use of prescription opioids is due to some people selling their drug, stealing or sharing drugs, by visiting multiple doctors to obtain prescriptions or by lying to doctors about their symptoms.

There have been a rising number of deaths from overdose of opioids and it is clear that opioids must be carefully managed. The Canadian Drug Policy Coalition sees overdoses as entirely preventable and has outlined an evidence-based, five-step plan for reducing overdoses in Canada.

The Nova Scotia Prescription Monitoring Program (NSPMP) was established in 1992 to promote the appropriate use of, and reduce the misuse and abuse of, narcotics and controlled drugs in Nova Scotia. It is a government-funded program administered by Medavie Blue Cross.

The NSPMP reviews prescribing patterns throughout the province; individual prescribing practices; and patient use of controlled drugs through the use of individualized triplicate prescription pads.

A recent Canadian study of 13,032 individuals and a review of prescriptions for opioids from a representative sample of 2700 retail pharmacies across Canada found that in 2009, the prevalence of prescription opioid use was 19.2%. Use of prescription opioids outside of what was intended was 4.8% and the use of opioid pain relievers to get high was 0.4% i.e. less than half of one percent. Many of the people using opioids outside of what was intended probably got drugs from family or friends because they had pain and could not get proper pain management.

Pain experts generally emphasize the need for pain management; addiction experts usually emphasize the problem of addiction. Unfortunately, many family doctors are not trained in managing chronic pain and thus may decline taking patients with chronic pain especially if they are using opioids for pain management. They may fear being monitored or investigated by the NS Prescription Monitoring Program and may not want the burden associated with the additional administrative requirements for opioid prescriptions.

The International Association for the Study of Pain asserts that adequate pain care should be considered a fundamental human right that should not be denied.

Pain patients are often caught in the middle and can be totally vulnerable.  The consequences to patients of inadequate pain management or drug overdose are often catastrophic.


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