How do physicians tell the difference between a patient with chronic pain and a drug seeking patient? It's difficult even for experienced pain management physicians. Some of DEA's recommendations on spotting drug seekers make it difficult for patients who have dealt with pain for many years and know what works and what doesn't. SEE Recognizing the Drug Abuser below
A patient that's suffered chronic pain for many years has been through it all with doctors, tests, and medications. Usually when a patient goes to a new primary care physician they tell them what medications they take and why.
If a pain patient knows what medications they've used in the past or are currently taking that work, the physician looks at the DEA Drug Abuser Profile it says "May show unusual knowledge of controlled substances". In other words tell the physician they take opioids and you're an instant suspect.
Physicians are taught (since the very beginning of medical school) that any patient requesting pain medication is to be Scrutinized" and to be "Wary" of them especially if they tell you they can't take anti-inflammatory drugs, that is a sure "SIGN" of addiction.
NSAID's are also what put me in the emergency room throwing up blood. Then there's the fact that NSAID's kill 17,000 people a year in the hospital, and we don't know how many from OTC NSAID's. As an EMT we could diagnose a GI bleed from the front door, it's not something anyone should go through.
And God help you if you have nerve damage at L5 S1 like I do. When a pain patient tells a physician that their big toe and the next one is numb, or the outside three toes are numb and edge of your foot gets shooting pains. DEA says these are textbook symptoms, and something to watch out for.
In 1996 the Kingman neurologist who did my nerve conduction study spent half an hour lecturing me and telling me nobody in Kingman would give me opioid pain medications.
Then he did the nerve conduction study. He said "it was textbook" for L5 S1 nerve root damage, and gave me a prescription for opioid pain medications...... Wow... Now medical textbooks are wrong, or right?
No wonder pain management physicians are confused...
If the article below wasn't true, it would be funny.....
D.E.A. Defines Drug Seeking – Try not to Laugh
This is from http://recoveryrocks.bangordailynews.com/2013/09/03/addiction/d-e-a-defines-drug-seeking-try-not-to-laugh/
- Unusual behavior in the waiting room;
- Assertive personality, often demanding immediate action;
- Unusual appearance – extremes of either slovenliness or being over-dressed;
- May show unusual knowledge of controlled substances and/or gives medical history with textbook symptoms OR gives evasive or vague answers to questions regarding medical history;
- Reluctant or unwilling to provide reference information. Usually has no regular doctor and often no health insurance;
- Will often request a specific controlled drug and is reluctant to try a different drug;
- Generally has no interest in diagnosis – fails to keep appointments for further diagnostic tests or refuses to see another practitioner for consultation;
- May exaggerate medical problems and/or simulate symptoms;
- May exhibit mood disturbances, suicidal thoughts, lack of impulse control, thought disorders, and/or sexual dysfunction;
- Cutaneous signs of drug abuse – skin tracks and related scars on the neck, axilla, forearm, wrist, foot and ankle. Such marks are usually multiple, hyper-pigmented and linear. New lesions may be inflamed. Shows signs of “pop” scars from subcutaneous injections.
Now, for all that the D.E.A may be on top of, one thing is certain: grammar is not their specialty. I cut and pasted the bizarre number of semicolons directly from their site.
Given the D.E.A’s antiquated and stereotypical findings, how are we to convey our needs to prescribing physicians and clinicians without creating the appearance of drug seeking?
Jim’s Corresponding Do’s and Don’t’s for Reporting Pain & Ensuring DEA compliance:
· Ok – nobody knows for sure what “unusual behavior” is so everybody be cool and ACT NORMAL! (while experiencing high levels of pain)
· It seems assertiveness is bad. Please stop advocating for yourself just do what they say....
· Ok – let’s not look bad when we’re in excruciating pain and don’t go showing up at the ER wearing your Sunday best.
· Stop reading
WebMD immediately. You might learn too much about your health conditions and appear sketchy
· Ok – bad news: being poor and not having a PCP or health insurance just became suspicious.(Wow, really?)
· If you have a chronic pain condition – something really scandalous like being an above the knee amputee, don’t explain that you know which meds work for you and which do not. It’s important that the doctor do trial and error each time.
· Feign interest in the medical terminology your doctor lodges at you. Don’t just take the discharge papers home and call the medical professional you’re distantly related to from home. Hang on every word your doctor rapidly spews as though it’s fascinating.
· No exaggerating! Describe your high pain levels in um, reasonable ways…
· Mood disturbances are bad – no mood swings as you sit in the ER for 4-6 hours. If you’re feeling suicidal, don’t tell anyone. If you’re having sexual dysfunction get online and order meds like everyone else.
· Ok. I concede the final point. If you’re showing up with track marks; it’s beyond time to get help.
