Medical question about under-prescription of pain meds
May 13th, 2008I’ve asked a question over at Kevin MD (on the topic of the over/under prescribing of pain medication) but I thought I might post it here too, just in case I have any medicos who read me.
Is it possible that doctors who fear over/mis-prescribing pain medication to drug-seekers, might under prescribe for people in genuine pain.
In my case I had a kidney stone with a stent that was extremely painful and debilitating. I was prescribed Tramadol (can’t remember how much) and it barely took the edge off the unrelenting pain of the stent. It meant I wasn’t screaming and gnashing my teeth in bed, but it wasn’t strong enough to allow me to do much more than barely survive until I could get the stone and stent out.
Would there have been stronger pain medications that I could have been prescribed that might have let me get up and around (not to mention get back to work) for the three months it took for me to get my stone and stent out?? And if so, why wasn’t I prescribed them? (I did tell every doctor and specialist I could get my hands on, how much I was suffering with the stent.)
(As a side note, I’m a Muslim and have never taken illicit drugs and have a religious prohibition against taking them.)
A Melburnian Muslim convert blogs religion, academia and life in general.
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Um, yes, doctors underprescribe all the time. I realize you are in Australia, so it may be different than here in the U.S. We have had studies that prove that doctors intentionally underprescribe to people of color by a huge percentage, and have no shame saying it’s because they are afraid that “those people” might be users. On the other hand, they not infrequently are quite generous with pain meds for relatively minor things for white people.
We also have a significant problem (regardless of ethnicity) of underprescribing for the elderly and young children. And a significant problem with underprescribing for the uninsured in order to keep costs down.
Sometimes it’s just the doctor though. Some just tend to prescribe lightly, and don’t understand the level of pain the patient is dealing with. Also, they rely on the patient to communicate when something isn’t working.
On a side note, for kidney stones, they often don’t offer any pain medication at all. There are certain things that they just don’t offer it… I had a very painful surgery last summer where I was offered only a local anesthetic (that hurt almost as much as the procedure itself, LOL) and a Vicadin. I had to ask for the Vicadin, because this particular procedure they don’t typically give that much but alot of women have complained. I was given only Vicadin afterwards and it barely helped but did make me so sick that I decided to cope with the pain without it. I was advised by a nurse that for my surgery this summer, I need to insist on something other than Vicadin for afterwards because she says I will definitely need something, and I should not be limited to one option that makes me ill. I didn’t realize that I could demand something different from my doctor until the nurse told me!
“We have had studies that prove that doctors intentionally underprescribe to people of color by a huge percentage”
Subhanallah! Racism by prescription!!!
“Also, they rely on the patient to communicate when something isn’t working.”
See, now I don’t think I probably communicated enough to the doctors and specialists just how debilitating the pain was. In my case it wasn’t the kidney stone that was giving me chronic pain (that was just the first pain that got me in the hospital), it was the bloomin’ stent that was keeping my urethra unblocked whilst waiting for the stone to be removed.
I am allergic to all sorts of metals, I can’t wear any earrings except stainless steel, gold and silver, I get irritated if I have plastic next to my skin for any length of time, I’m allergic to the glue on Band-Aids etc. so I am pretty sure that I was pretty sensitive to the stent inside my body. It was pure agony, unrelenting agony.
But I did expect that my doctors would prescribe the appropriate painkillers, and thought that the Tramadol was the most/best they could give me.
(I had Pethadine and Morphine in hospital. The former was great, the latter just made me dizzy and sick).
I am now starting to wonder whether I was under prescribed for pain medication. Should I have kicked up a bigger fuss and insisted on stronger meds? (If only to make me aware for next time, God forbid).
“I was advised by a nurse that for my surgery this summer, I need to insist on something other than Vicadin for afterwards because she says I will definitely need something, and I should not be limited to one option that makes me ill. I didn’t realize that I could demand something different from my doctor until the nurse told me!”
That’s the nail on the head! I never imagine that you could insist for something stronger!!!
Insha’Allah
, Allah 
has healed you of your complaint, and in our sufferings may He forgive us our sins.
It appears to me that pain management in hospitals is primarily handled by nurses rather than doctors - not so much that the nurses authorize the use of the drugs, but that they are the ones who are talk to the patient for more than sixty seconds! An essential problem here is that there is no objective way to measure the level of pain, so they are very reliant on the patient to communicate it. I notice that these days (in the Melbourne hospitals) that the staff ask you to describe your pain level on a scale of 0 to 10 (where 10 is the worst you have experienced); seems crude, but a tad better than just guessing. It is especially difficult with outpatients, who have little contact with nurses, and are reliant on prescriptions (especially since some of the more effective drugs such as morphine are highly addictive). It must be especially hard for people with chronic pain (eg back pain) to justify their medication without appearing to be malingering.
Spot on.
When I was in hospital and the nurses saw what pain I was in when the kidney stone was giving me grief, I was given pethadine a number of times. It was when I was out of hospital, after I had the stent put in (and hence the kidney stone wasn’t troubling me but the stent was) and not seeing any medical professional except for short consults that I ran into trouble.
I didn’t think about it at the time, in fact it’s only now that I am thinking about my pain management, but at the time all I could talk to the doctors about was getting the stent out, rather than discuss a pain management plan.
Back then I naively assumed that what I was given was the best I could hope for. I didn’t realise I could say “this isn’t working, what’s the next option?” (Duh, me).
Part of it I think was subconsciously not wanting to be trouble to the doctors and specialists, because my faulty cognition was that if I was trouble then they wouldn’t help me (I’m seeing my therapist about this pleasing-problem hah-hah!). So I didn’t make too much of an outward fuss, but grinned and bore it.
I did the same when I had whooping cough and asthma complications that did eventually land me in hospital. At home I would have this paroxysms of coughing where immediately I would lose all control over my bodily functions (wee, throw up, bleed etc.). Now, because this was awfully embarrassing, when I went to my GP (twice) to say I felt sick, I did everything I could *not* to have a coughing paroxysm in front of him. I barely moved or breathed. So, he never saw me actually with the problem.
Eventually, I got hubby to drive me to the hospital one night and the nurse said I should have come in weeks earlier.
LOL! That asthma story is hilarious! But in a nice way, if you get me
Alhamdulillah you were ok - asthma can be a bit scary like that - people often think they are over reacting but it’s so much easier to treat in the early stages.
I am not a doctor so am not sure if there was anything stronger for you than the pethidine and morphine (which are restricted drugs so they need to be administered by a doctor) You could have had something like a fentanyl patch but also, am not sure how that would have affected your ability to work, drive etc.
The opiates are very effective in controlling pain but because of their side effects - respiratory depression, nausea, constipation, dependency etc I don’t think there are many out there that you can get on prescription to take at home (apart from tramadol and the codeine preps)
In hospital, it’s much easier to “dish out” the good stuff.
Yeah *sigh*. I was on Tramadol but that barely took the edge off at all. My GP finally prescribed me something I had to insert up my bottom (seriously!!) that also took the edge off a little bit more, but it was the sickest I’ve ever been and good grief, I think health is the most valuable thing now. And Allah
is the Healer.
As for my WC & asthma, my paroxyms were so violent that the veins in the whites of my eyes burst as did around my eyes, so I had to big black Panda eyes and no whites (just all red). People used to give Abu Yasmin dirty looks when he was visiting me, ‘coz they thought he had beat me up - seriously!!!
I was in an accident with a semi-truck back in 1987 and suffered many injuries especially back and neck. I was always put on anti-inflammatories for 10 yrs. In 1997, after moving and finding a new GP, he prescribed Lorcet 10 mg. 4x a day which helped. I was on them on a daily basis and took them as prescribed. In 2000, after moving, my bulging disk slipped and the only treatment that would help would be surgery. It was the largest herniated disk the surgeon had ever seen. A year later, I had to have another surgery for another slipped disk. I stayed on the Lorcet. In 9-2003, I moved to another state 800 miles away. The 1st GP I went to after showing him my meds would only prescribed my meds EXCEPT Lorcet telling me he couldn’t “RX that medication” I told him “you mean you won’t.” I used to work in a neurologist’s office for 12 yrs. and I know when a dr. is lying to me when RXing meds. Though I left my medical career that I loved, I have kept up with advances in pain meds and laws. I found a new GP who RXed Lortab 7.5 mg. 3x a day. Well, after yrs. of finally getting my migraines (I take Imitrex) under control, they started coming back everyday so I called a neurologist for an appt. He’s also a pain specialist. What does he do? He takes me off the Lortab which helped very much and puts me on a stronger med, controlled released morphine 30 mg. once a day. According to the PDR (medicine book drs. use), drs. should not put you on any stronger meds than you need to be on. I should not have been put on the morphine unless the Lortab/Lorcet didn’t help. I fail to understand his logic. He is very against RXing Lortab, Lorcet, Oxycodone, Tylenol or Empirin with codiene (which I can’t tolerate). I am a chronic pain patient and on disability. I had a 3rd surgery on my back and a bulging disk in my neck. I have been on the morphine for 4 yrs. In the past 1.5 yrs., I have asked him to go back to Lorcet or to increase the morphine (I’d rather have Lorcet—it works beter for me) and he refuses. All he wants to do is give me cortisone shots that work for a couple days and a new P.T. treatment that stretches my vertebrae to give relif which does not work. Because of the accident, athritis had now set in with degenerative disk disease. My spine is falling apart and I was told I would end up in a wheelchair. When I seen my neurologist a couple months ago, he told me he was going to do urine drug screen (I DO NOT take illicit drugs or any drugs not RXed to me). I was unable to give him a sample and the nurse told me to come back the following week as he is only in this office 1 day a week. BTW, they put in my chart that I REFUSED the test. I went back expecting to be there only 10 minutes. They didn’t do the test and put me in a room to talk to him for a few minutes (I needed a P.T. script). He came in after 2 hrs. (by then, I was very irritated waiting that long) and told me that state law requires him to do random urine screens. I knew he was lying. There is not one state in the U.S. that has that law. If there were, there would be alot less drug addicts. Just to be sure, I checked with the DEA and state medical board, my lawyer friend in the previous state I lived in and my paralegal friend here. I seen him last month. No test. I seen him last week and he was testing all his patients. I had gone to the restroom while waiting so I went in the bathroom to give a sample but could not give enough for the test. He told his nurse to mark it in the chart. I usually see him once a month but was told to come back in 2 wks. Everyone was. I’m wondering if he is in trouble with the state or something. No other drs. I see do not know of this so called “law”. I did read on the internet that some drs. make it a common practice. I do think drs. underprescribe but I don’t think my dr. was right to put me on something alot stronger when the current pain med I was taking was working.
This is not really about the pain meds but I came across a website of a holistic center in Nevada that has a lot of experience in helping people get rid of kidney stones etc… in a natural way, within a short amount of time. No idea how but I guess its probably a heck of a detox diet!
Umm Layth: I’d imagine lots of cranberry juice in Nevada hehehe. A lot of kidney stones can be passed but apparently that hurts lots. Mine wasn’t going anyway unfortunately. Now I do drink lots of water!!!
Dreamkatt: that sounds like a horrific nightmare, I am so sorry. I really don’t think there are a lot of doctors out there that understand dealing with chronic pain, maybe because they like to ‘fix’ things rather than ‘cope’ with things, I am not sure (I am not a shrink). Have you actually seen a specialist for dealing with pain (rather than specialists for your conditions?) They do exist, although I am not sure in America if they are there?