Braised Lambchop you know what? pain really sucks

you know what? pain really sucks

I haven't written much about the experience of chronic pain. Today seems like a good time to do that.

For starters, I'll tell you about the fun of getting a refill on pain medication. Now this is a rant against the system, not necessarily against my physician and his staff (although it may seem like it; until very recently his staff has been rude and incompetent). People like Rush Limbaugh, whose own prescription abuse I briefly discussed here, are responsible for these convoluted rules and procedures.

The basics of my treatment: I've been through psychotherapy, physical therapy, massage, hydrotherapy, and trigger point injections. I have not yet had a spinal block, because my surgeon hasn't signed off on it, and there are more things to think about in my abdomen besides the pain - I had my large bowel removed, and the internal reconstruction is such that he wants to be present whenever I have a procedure performed - and I don't want to screw my gut up entirely. So, I have to make do with medication.

The first pain clinic I saw treated me for almost two years. The first doctor at that clinic was the one who did trigger point injections and tried to treat me with methadone, which is used for chronic pain as well as for heroin withdrawal. Methadone is very inexpensive and is underused for pain treatment. Unfortunately, I can't take more than 5 milligrams of the stuff without vomiting for the next eight hours.

The next choice, of the next doctor, was OxyContin. Remember when I said I had my large intestine removed? One side effect is that things move through my gut very quickly. OxyContin has a polystyrene coating on it, that is intended to make the drug dissolve slowly over a period of twelve hours. I couldn't digest the coating - or at least I couldn't predict when I was going to digest it. Sometimes they would come out whole in the toilet, two or three at a time, and other times I wouldn't see one for eighteen hours. I was taking five a day, and I think I was getting the medication of one. Right around this time, though, a lot of media attention was being paid to OxyContin addiction (including idiotic anchors just giving out instructions on how to abuse it on the morning shows, which made me terrified I was going to be robbed), and when I asked for more medication because of the toilet tablets my doctor didn't believe me, sent me a certified letter calling me an addict, and dismissed me from his practice.

This happened on a Thursday; by Sunday morning I was in opiate withdrawal. I don't remember a lot about it, because the jerk was kind enough to phone in some Librium and Clonidine for the symptoms he knew I was going to have, but it was bad - I couldn't be still, shaking constantly, and I was having hallucinations. John got in touch with my original gastroenterologist, who saved my life once, and he did it again; he called a friend of his who was new to pain management practice, and I saw him that next Tuesday.

This doctor, who is my current provider, brought up the obvious idea to use transdermal medication instead of trusting my gut to deliver the drug to me. Two days later, the withdrawal symptoms were over and I felt better than I'd felt in over two years. And I've been on Duragesic patches ever since. I stayed with the breakthrough oral oxycodone tablets for two months, but it wasn't working, and he switched me to a kind of lollipop with medicine in it at the next appointment, which means that my gut isn't responsible for delivering any medicine at all to me - it's all done through my skin and the mucous membranes of my mouth.

I've been pretty satisfied with my treatment from this guy up to this point, except for the monthly Prescription Dance. This is where my rant begins.

The Drug Enforcement Agency rules say that:

no Schedule II drug prescription can be for more than 30 days of medication;

the refills cannot be called in, they must be written;

at least two copies have to be kept, one at the provider's office and one for the pharmacy;

and, in Oklahoma, the prescription expires five days after its date, so you have to get it in to the pharmacy quick or else.

So, every 30 days, I have to phone in to this refill line and answer the same questions about the same drugs that I answered the previous month and the previous 51 months before this. If I don't do this exactly right, and I mean exactly right, neither calling too early or too late, I don't get my refills. They ask for my phone number on this recording, but not once in three years have I ever received a phone call regarding my prescription refill. I could give them the number for Graceland and they wouldn't know the difference and probably wouldn't care.

Imagine that you want to take a trip with your spouse. You pack your bags, make your hotel reservations, and go. Not me - I have to see if my refill is due anywhere in the time while I want to go and the two days after, and then I have to ask permission of the prescription staff at my doctor's office. If my refill is due on one of the days while I'm gone, I have to have the medicine in my hands on the day I leave or I'll start withdrawal. The problem is that if I do that too often, especially if I need the refill three or four days early, the staff starts to suspect me of abusing the drugs, because they're told to watch out for people who want early refills of their narcotic prescriptions.

Plus, since the first of this year, the person responsible for the 'prescription refill line' at my doctor's office hasn't been doing their job. Once I called in on a Thursday to pick up the refills - remember, these are physical pieces of paper, every month - on the next Thursday. This girl decided I had called in too early, and she decided to ignore the entire thing. They didn't call to tell me I'd called too early. They didn't call to tell me to call again later. They just decided I had broken 'the rules,' and I should be punished for my transgression by not getting my prescriptions.

Two months ago, John goes down there (and mind you, this is a 100 mile round trip for us - we can't trust the mail to get them here on time or even at all, so we have to drive down and get them in Tulsa) and they tell him that my doctor is out of town and, because one was due that day and the other wasn't due until the next Tuesday, I would just have to wait until next week for both. He was so furious with one of the receptionists and her smug attitude he was about to have a stroke. This month I finally got what I asked for when I asked for it, but I'm not hopeful it will last.

The next step after medication is probably either the spinal block or an implantable pump to deliver morphine or fentanyl to my spinal cord. I don't want to do that, because I had trouble after the epidural I had with my second childbirth, but it's probably inevitable. In the meantime, I'm going to have to go up on my medication next time I go in, in August, because I haven't had a dose increase in over a year and I'm starting to suffer.

And, because of his staff, I think I'm probably going to have to find yet another pain management doctor. This time I'll most likely have to go to Oklahoma City. I like my doctor very much, and his NP is okay, but I think they're tired of me and what they probably consider my 'whining,' and I'm really worn out with their office staff. Not one of them realizes what it's like to have to live their lives around the whims of hourly employees who don't give a rat's ass about anyone but themselves, and somewhere there's just got to be a better place and a better group.

Or not. But at least it's worth looking.

Next time, I'll tell you what it's like to have your teeth rot right before your eyes.

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