I am rated 30% for degenerative disk disease in my back. I have tried around 10 different medications for chronic pain. I have been to numerous physical therapy appointments at the VA medical facility in Decatur GA. The only option rationally left is narcotic pain killers. The pain is ridiculous sometimes i cannot even get out of bed or walk up steps. Yet my primary care doctor will not prescribe me anything but these futuristic placebo type medications that dont even work on a head-ache. Has anyone else had experiences like this? If so how did you deal with it. I mean what do they want me to do buy street drugs to deal with my chronic pain, so they can take away my benefits? I have no history or family history of alcohol or drug abuse. Passed numerous urinalysis through VA exams. So what is the issue of prescribing these thing? I would rather face the possibility of addiction than chronic pain. Soooo frustrating.
Hi, I made a reply on the VA thread in the General Section. I think it might help you with the VA. Oh, Dennis had the same thing, he had back surgery and he is doing better now. He can stand up while he is peeing. And he can walk a little better. The pain is not so bad now, only when he walks too far and picks up something heavy.
Go check out your other thread.
YOU have a right to be as pain free as pain free as you can possibly be, and that includes the Rx of narcotics.
If your PCP has an issue with Rx of narcotics, ask what and why that is. If the issue of Rx narcotics cannot beresolved between you and your PCP then see the PCP
s supervisor. You can demand to be prescribed narcotics if the pain reaches a threshold inconsistent with normal daily functions.
EXCEPTION: If you have a history of past drug abuse, illegal usage etc., alcohol abuse. Then your VAMC and PCP has the right to deny narcotics. Read the Patient Bill of Rights, posted nearly in all clinics.
Proud member of the: DERLICT VETERANS GROUP
Google "va pain is the 5th vital sign toolkit" and you'll come up with a plethora of results.
And this should be the title of your 1st hit: "Measuring Pain as the 5th Vital Sign Does Not Improve Quality of Pain Management".
You ain't the only one that; asa disabled vet, has presented yourself to the VA for treatment of chronic or unrelenting pain associated with one or more service connected disabilities and essentially left with the same thing ya came in with, nothing but pain.
When ya google "va pain is the 5th vital sign toolkit" make sure ya find and read the PDF document the VA has published about treating Vets W/Pain. More than likely you'll find that whatever Doctor yer seeing at whatever VAMC yer going to essentially violates about 95% of the VA published document.
Matter of fact, print it out(all 57 pages!!) and bring it with ya to your next appt. Odds on bet the VA Doc ya hand it to and has never even seen it, never mind read it.
And the VA has no such policy that automatically or specifically excludes you from narcotic pain medication based solely on past drug or alcohol abuse.
I'm an alcoholic thats been clean and sober for over 15 years, and at one point "post sober" I received a 30 day supply of percocet every 30 days for over 3 years based on nothing more than a phone call to my Ortho Doc requesting the script be refilled. And ;more often than not, I wouldn't even talk to my Doc, I'd talk to the Ortho clinic secretary, and 5 to 7 days later a new 30 day script of perc would arrive in the mail.
No pee tests, no blood work, no pill count. My Ortho Doc was a regular full time staff Ortho guy(versus a "D.I.T" Doctor-in-Training AKA resident), also Ortho chief of staff for 3 VAMC's, and I'd been seeing for well over 10 years.
All I wanted was something to "take the edge off"( I live 7+ daily on the pain scale, and have for MANY years), and because of the long Doctor-patient relationship we had, I understood him, he understood me, and he fufilled my request every time.
I don't take anything anymore save for 2 tylenol 500MG right before I hit the sack. I don't drink, don't smoke(weed, smoke butts), or take any other form of illegal drug.
Ya learn to live with it afta awhile. I have, you will. Don't rely on the VA to give you anything consistently for pain management. Last time I went to VAMC's "PAIN CLINIC" the only thing the "D.I.T.S" would do is pain injections. Already had all of 'em before, don't like 'em, didn't want 'em, so I got nothing.
Like you said, all the VA wants to hand out is these "wonder drugs" that "cures all", and they don't. These meds have more serious adverse side affects than they do benefit(ask me how I know this, can you say MIRAPEX??)
These Doctors(???) are more concerned with damaging their reputation and credentials because they "created an addict" than they are with proper and effective pain management and control. It even says that in the "Pain as the 5th vital sign toolkit" PDF document published by the VA.
Also understand that the policies, rules, and regulations that govern how a VAMC operates "trickles down" thru that VAMC's Directors office. And that Director is usually a non-medical ADMIN type who's appointment to that Directorship is a "quasi-political" appointment. And they ain't gonna implement or do ANYTHING that can rock their career boat(ask me how I know this!!). I even have a letter from my VAMC's Director(VAMC Jamaica Plain Ma.), a non-medical ADMIN type, where he states to me(in a letter signed by him mind you)that "he has directed" the Neuro staff at "his" VAMC how to medically take care of me.
He apparently also directed that VAMC's patient advocate to no longer communicate with me as I've not been able to talk to them(via either phone or the VA's "IRIS" system) since right after I received that letter.
I also forwarded a copy of said letter to my VISN Director asking what right the VAMC's Director had to say such things, I've never heard back from them either.
And it wasn't about Pain Meds, it was about pretty marginal levels of quality in my care. Pain Meds was included in the issue as I couldn't get any from the VA, but the primary issue was lack of decent medical care.
So ya ain't alone Brother, not even close. Its WIDELY recognized that the VA does a pitiful job in dealing with Veterans Pain Management, and they have for a L-o-n-g Time-JRC
I didn't read anywhere in your references any rights patients have in terms of being proactive and partner in deciding what pain medications are prescribed.
As it stands now, the Physician is not required to consider your request for a certain pain medication (even though you know, feel and experience it) and you may want to try different meds. I read into it that everything is subjective.
My understanding of the past posts is does it state anywhere (other than internal memos) that if the patient requests a specific medication because he/she knows it works better for them over the one that the Physician wants to Rx (we are talking about legal drugs) how can that patient advance his/her preference without triggering that RED FLAG in their file (there is one on the p.c screen - top right) indicating i,e., disruptive patient - angry etc.
The search you provided showed what most veterans already knew...they do ask you the pain levels etc., the question then becomes what happens after the initial screening and you see the Doc,,,and he/she wants to Rx you (X) and you prefer (Y) because you know something the DOC does not, and that is..you and your body and your pain and life compensation of those things.
I pretty much agree with the general statements you've made, alot of it is subjective. The fact that I got percocet every 30 days for 3 or so years on nothing more than a phone call I'd say was fairly subjective. There was appointments, but I could get it refilled every 30 days witha phone call, nothing more. I'd say my ability to do that was based almost exclusively on the long term Doctor-patient relationship(and his extensive experience) I had with this Ortho Doctor.
I saw him every 45 to 60 days for almost 10 years, and aside from the relationship we built, he had almost 10 years of medical documentation, interpreted by him, to make any and all medication decisions. And they were all done with my input and participation. If I was in "drug seeking" mode I coulda had alot more than just percocet, I was offered oxycontin, demerol, and morphine sulfate. I DID take the oxycontin once, during a winter when i was a flat out 10+ on the pain scale. I took it for 3 days, and that was it. I flushed it, suffered for 27 more days, and went right back to the Percs. Beyond me how anyone gets addicted to that crap!!!
I should also say this is all past tense, I haven't taken and narcotic pain killers(prescribed or otherwise) in at least 5 years. Like I said, ONLY medication(legal or otherwise)that enters my body is 2 500mg Tylenols as I'm heading to bed. I had a VERY STRONG negative reaction to one of those "wonder drugs" the VA prescribed me(Mirapex), and take nothing anymore. I took Mirapex for over 18 months, it built up in me, and really screwed me up. I stopped taking it just about a year ago, and still suffer the repercussions from taking it. And; from everything I've been able to read about it online, always will.
THAT necessarily isn't the VA's fault. I researched MIRAPEX before I took a single dose,and have now found that drug manufacturers VERY MUCH downplay the potential very negative side effects of these "wonder drugs".
But it also IS some of the VA's fault, I wanted percocet, and they wouldn't give it to me.
I don't know where(or if) you go to a VAMC for medical care, but the one I go to(VAMC Jamaica Plain Ma.) all clinics are now 100% staffed by residents, or as I refer to them, "D.I.T's"(Doctors-in-Training).Only clinic staffed by "real" experienced Doctors is Primary Care. My 2 main clinics are Ortho & Neuro. And the longest I've had a "D.I.T." in either of those clinics see me asa patient is 2 years,and that was once in Neuro. All others, one year. Shortest availability on appointments is now 90 days, more often than not its between 4 and 6 months, so "if your lucky" you'll see a "D.I.T." in your clinic MAYBE 4 times ina year. And then they're gone, and ya start all over witha new "D.I.T.", and you ARE "reinventing the wheel". Not much of a chance to form any kind of a patient-Doctor relationship. My ortho Docs still around, but he now oversees the OR and oversees the overseers in the Ortho Clinic. In 3 different VAMC's.
And I know about the 30 day appointment rule, but I also know how the VAMC's; at least the one I go to, gets around this.
So its very difficult, if not actually impossible, for a patient to build a relationship with their VA "D.I.T." to the point where that "Doctor" can actually involve being subjective and decide "I've known this patient for awhile and feel comfortable prescribing them narcotic painkillers". MUCH easier to "just say NO" and prescribe them some wonder drug. That there really isn't alot known about.
And then there's Part #2- D.I.T.'s are "brand new" and I'm pretty sure the last thing they wanna do is start prescribing narcotic pain killers to anyone. Then we throw in the fact that they are "doing their time" at a VA Medical Facility; where I imagine there is ALOT of internal policy and memo about prescribing narcotic pain killers, and they ain't writing nothing for nobody. Whether you need 'em or not, whether you have reams of medical documentation or not quantifying your injuries and page afta page of you saying "I'm in pain", ya ain't gonna get 'em.
But they will hand out TRUCK LOADS(or should I say big brown shopping bags) full of anti-depressants, anti-psychotics, and other "wonder drugs" that have been identified as havin "off-label" uses in some physical injury or disability.
Heck, if I was in straight "drug seeking" mode all I'd have ta do is pay $68 for an appointment at my local community healthcare center, go to the appt, say "my back hurts" maybe show 'em a copy of my last MRI's writen report documenting the extensive issue in both my lumbar and cervical spine(all service connected), and I'm sure I'd be walking outa their witha script for whatever pain killer I wanted. Probably do the same thing at my local Civilian Hospitals ER as well.
My VAMC's PAIN MANAGEMENT CLINICs standing defacto policy is "PAIN INJECTIONS ONLY", they ABSOLUTELY WILL NOT prescribe a narcotic pain killer for anyone, anytime. And thats from the VA Staff Doctor in charge of the pain clinic.
My last VA Pain Clinic appt there were 3 "D.I.T.'s" in my appt, it was like watching the freaking "Three Stooges", Mo, Larry, and Curley. And when my wife went to walk into the exam room with me(she goes into almost all my appts, she sits in the corner and takes notes), one of the Stooges blocked the door and said "ya can't come in, ya have to wait out here"(a DIRECT contradiction of the stated Patients Bill of Rights which; by the way, was hanging on the wall right above the chair she sat and waited in, I took a picture of it and her with my cell phone), believe me when I tell ya that THAT appt went down hill from there.
And yep, I know about them RED FLAGS as well, don't really care. Do I have one on my file?? No Idea, I can guarantee ya I've argued and become "hot under the collar" on more than one occasion with these DIT's. And multiple Patient Advocates. Got spoiled by my 1st "PA", was the nicest, most pleasant, do anything to help the vet person I've ever met. On parallel with my old Ortho Doc. She sadly retired about 7 years ago, and its been downhill since then.
And I WAS always involved in my medication decisions, policy or not. Whether the DIT wanted to hear it or not, they did. And on more than one occasion they heard from me "don't bother prescribing it cause I won't take it". Or "I don't want "X" , I want "Y".
When my Mother died of Cancer in 1990 My Father, sister, and I watched some of Bostons Best Doctors at one of Bostons best hospitals screw up by the numbers. She was gonna die anyways, but they didn't take appropriate action, she was in there 9 weeks and they didn't know what she was dying of till 3 days before she passed(cause they didn't read her past medical records, ALL from the same hospital).
So, we all learned from that. When my Dad passed in 2004 "were on" every Doctor on his treatment team every day. And that included my Father till he was too sick ta do it. When he had his hips replaced several years earlier we were the same. Not mean, not over bearing, but WHAT are you doing and WHY are you doing it. And had NO PROBLEM kicking it upstairs when we didn't like the Doctor, or didn't like the anwers.
And I carry that same mentality today at the VA. Whether its VHA or VBA.
Sorry, didn't mean to go on so long, but there ain't an easy, straight forward answer or solution to any of this. I been dealing with the VA at some level since I got out of the military in 1981, and I've been 100% since 1995. And I wish I'd never been any percent.
I served my country twice. Once in the Navy(72-75), then again USCG(77-81), and I was proud to serve both times. And now I'm a Disabled Veteran , injured doing the job the USCG was paying me ta do on active duty. And I regret the fact that THAT injury ever occured and led me to where I am today in 2009.
And whether it be timely and appropriate prescription of pain killers or quality in level of care, if the VA Healthcare System is the best this country can offer to its veterans, disabled or not, we're in trouble.
Oh...., thats right, we ARE in trouble. Wait till the 500K or so come home from the middle east looking for help from the VA-JRC
Had an appt last thurs with my PCP. He said the patient bill of rights has nothing to do with narcotics and he said degenerative disk disease does not warrent prescribed narcotics nor will he prescribe them because that is malpractice. Then he put me on this new drug called Gaba something without me having any say so in the matter. I am done with the VA i am have an appt with a REAL doctor coming up i am paying out of pocket for.
I suppose it's easier to go out of the VAMC system for pain relief, but you might consider pressing the issue instead. Keep in mind that different doctors have different views on pain and narcotics, and since they can only relate to your pain and suffering from what they read and studied.
I have have run across doctors in the past who are adamant in their beliefs about narcotics, and others who have a better appreciation for pain. You have the option of speaking to the Physicians supervisor as well as the Patient Advocate. By all means voice your concern. You do have an inherent right to be as pain free as possible, often, it comes down to how you communicate it. I know that other medications may be tried first, for instance "naproxen" as some try to avoid the use of opiates. Over 90% of the PCP's are "residents" and thus are still stuck in the mentality of their teachings. Time and experience lacks, so, consider taking it up with advocates who understand the veterans and who have a greater appreciation of your unique issue.
These things kinda remind me of a doctor I had to go see outside of my PCP clinic and who was hell bent in having my drivers license revoked because I kept failing some stupid test that required mental functions, seeing, remembering and repeating etc., because I have episodes memory concentration etc., for which I had been tested on 2 x a year...I took a bullet to my friggen head in Vietnam causing intermittent headaches w/severe pain and then for about a week after I would have problems ^ there. Finally I ended up walking out and said, no more. I then saw my PCP, explained what was up, so that she understood the what, why, when, where and she agreed with me then and since then never had to go back there again. The problem lies in what your PCP sees in your medical file, and had I not explained everything to my PCP, then it would have given the appearance that I was a disgruntled, uncooperative patient/vet. because of the notes the "other" Doc put in my file. Since then, smooth sailing...Try it !
Wait a min.....I thought Gabba was a anti-anxiety medication? You sure he perscribed Gabba? If he did, me thinks he feels anxiety is one problem as he probably also has you on Naproyxn.
I think getting that second opinion is a smart thing to do.
THE ROLE OF GABA IN THE PATHOGENESIS AND TREATMENT OF ANXIETY AND OTHER NEUROPSYCHIATRIC DISORDERS
The treatment of anxiety disorders has evolved considerably in the past 50 years. There was early use of alcohol and barbiturates to treat anxiety, but both were associated with significant problems. The situation changed in the 1950s and 60s, when the benzodiazepines were developed as effective anxiolytics; these agents are still commonly used today. The benzodiazepines work quickly and are generally well tolerated. Their primary disadvantages are initial sedation, ataxia, incoordination, impaired memory, and cognition and, after chronic adminstration, physiological dependence and the potential for withdrawal symptoms upon discontinuation. Some of these adverse effects occur more frequently in older patients. The current faculty has also observed occasional undesirable behavioral disinhibition in pediatric patients and in patients with a comorbid Cluster B Personality Disorder (Antisocial, Borderline, Histrionic, or Narcissistic). People with a history of or propensity for alcohol or drug abuse are at risk for abusing benzodiazepines. Due to their lack of significant antidepressant effects, these drugs are also not optimal for long-term monotherapy treatment of patients with generalized anxiety disorder (GAD) or other anxiety disorders. As a result, there has been a continued search for new anxiolytic agents. Tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) proved to be effective in the treatment of some anxiety disorders, but enthusiasm for their use is limited by side effects, especially during long term therapy. Over the past several years, the selective serotonin reuptake inhibitors (SSRIs) have become first-line monotherapy for the anxiety disorders, because they are generally better tolerated and have a broader spectrum of efficacy than older agents.
That resembles me...No fair ! Now if you were referring to JIM-BO here, then alright..sooooo truee....soooooo truuue!
P/S Narcissist... THAT ONE I heard from my previous Shrink...right before I went over his desk to choke him.
that why we have what ever kind of meds the doc gives to keep us calm and oool,,
but never heard of that drug I take Klonipan
Be Well Stay Calm
I too have DDD and have been on pain meds for years the Manchester NH VA They just took away my pain med after years of being on them they have a gatekeeper mentality at primary care and won't let up to see the pain clinic who issued these med first of all, they started treating me with these med, they are if I have my way,going to continue treating me I have no outside insurance and no desire to go elsewhere IT IS MY RIGHT AS VETERAN TO BE TREATED THERE......this little peeon of a pc dr who i have had for 18 months said that he sees no reason for me to be on these med and that these meds are for cancer patients and broken bones only.I just don't get it he also broke 3 of my teeth and I think he has over looked serious other medical problem because all he could focus on for 18 months is my pain meds.I am not looking forward to being back in bed and eating tylenol.and destroying my liver.because I eat a bottle in 2 days with no relief....how do we stop this madness.
You can always request a new Doctor or movement to another clinic, I have a good Dr. and he adjusts my pain meds when needed.
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