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New state and federal regulations have put chronic pain patients' needs in the hands of pain clinics. I use a rather low dose (no more than 15 mg/day) of hydrocodone pain med for chronic anal fissure and sphincter spasms, which until this month my gastroenterologist has been prescribing for me. Now he tells me he can no longer prescribe them and I will need to get my pain meds from a pain clinic.

I have been to two pain clinics in the last 6-7 years, and at one I was offered methadone, but they could not offer norco/vicodin. What is it with pain clinics thinking all chronic pain is due to back issues, and all pain patients are addicts? The other pain clinic physician rolled out the list of meds they use, most all of which are contraindicated due to interactions or side effects. However I was offered "energy healing" treatments, which I tried and found to be a waste of Medicare's money.

I have an appointment in 5 days with my PCP to discuss whether she can prescribe my pain meds, and if not, how I navigate the pain clinic maze and hurdles. For gosh sakes I take three of the lowest dose Norco a day -- hardly a heavy user. But I guess abuse of these drugs is so rampant that chronic pain patients are now paying the price. I have read some horror stories about patients being forced to endure pain without meds that they have used for years with no issues.

I do not want to be one of them. If anyone here has knowledge or experience with navigating this new restriction on pain meds I would be most grateful. My pharmacist has warned me it could be a little bit of a trial and error struggle.
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I'm in California and my PCP orders my Norco and I can get refills by mail. But, the Rx is new each time (no automatic refills). The process is the same, where I request a refill online. It just takes an extra couple of days for the pharmacy to get a refill authorization from the doctor. The only thing new I am seeing is that after a period of time, the doctor has to write a whole new Rx with a new Rx number.

Originally, my rheumatologist prescribed, but it has since switched to my PCP. Since I have Kaiser, it was all automatic because all the doctors are in the same system. So I guess it is more streamlined in my case.

I have never had to go to a pain management clinic. So maybe it is a state by state thing.

Jan Smiler
Last edited by Jan Dollar
I'm in Oregon, and I know that many Washington State residents cross the border and come to Portland to see pain specialists.

From what I've been told by one disgruntled 'Couverite, the bureaucrats in Washington State think they know better than you AND your doctors, and act as physicians by proxy. (Tying the hands of health professionals so they are corralled into doing things a certain way.)

If you're up to a trip to Portland once a month, you might find things down here more reasonable. For the time being, anyway. Oregon recently changed from a part-time legislature meeting every other year for just a few months to meeting every year. We can probably expect an avalanche of laws as they dream up ways to protect us stooooopid citizens from ourselves and our doctors.

Don't give up on your hippie pain doctors, though. They MIGHT come around and realize that you are not addict and that you truly need narcotic pain medication. The question will be, will the government allow them to do their job?

Another option is seeking out an anesthesia group, rather than a clinic that specializes in passing out methadone to heroin addicts and whose waiting rooms are filled with neck brace - sporting lawyer referrals. Many anesthesiologists are also pain specialists, and are perhaps less jaded.

OK... so now that I have libeled legislators, lawyers, doctors, hippies, and the entire state of Washington, I think my job is done here. (plus it's the middle of the night, I'm half asleep, and God only knows what the hell I'm typing).

Last edited by PDXDavid

I find that methadone does reduce the number of bad pain incidents (spasms and excoriation pain that escalates into severe pain and spasms).

Once bad pain is present, the methadone is useless. But is does reduce the frequency of those episodes.

My pain doctor just day before yesterday put me back on Oxycodone, at a much higher dose than my GE doctor had me - which is a good thing because previously, I found myself suffering through hours of excruciating pain, unwilling to take oxycodone for fear that I would run out and be left with nothing if even WORSE pain hit.

Now, I have enough that I am pretty sure all my major pain episodes will be covered.

I certainly don't plan on changing and popping them for every little ache and pain. I'm very wary of becoming addicted, and frankly I don't like oxy at all - it makes me feel ookie and itchy. But, knowing that I have enough that I don't have to suffer needlessly is comforting, and a great weight off my shoulders.

I don't understand how people can derive enjoyment from taking oxycodone. I honestly find not a single recreational or pleasant aspect to it, except for the pain relief.

Good luck. I hope you find a doctor with the cajones to give you what you need. It seems from the many horror stories that some pain doctors view their mission as KEEPING you in pain, rather than relieving it. Maybe they are jaded. Maybe they are sadists. But they should get a job flipping burgers at McDonalds, because they have no business practicing medicine.

I agree with you PDXDavid. I take Norco for pain and don't get high from it. It is my understanding that if you use it as intended and do not use more than is needed that you will not become dependent. There are days I need to take all 4 prescribed doses and also have to take antispasmodics and better days that I only need to take 2 Norco and no antispasmodics. Those days are few and far between but they give me hope.
TE, that definitely is NOT true, but you are not the first to repeat the notion that you cannot get addicted/dependent if you only take opiates for pain and as directed.

All it means is that you will not be abusing the drug, but you most definitely are dependent if you take it on a regular basis. That is why if your pain somehow magically was resolved, you would need to do a gradual taper to avoid serious withdrawal symptoms, which often are interpreted as pain.

Jan Smiler
The difference is between being dependent and being addicted.

Dependence is when the body has grown used to it, and in order to stop taking it without your body reacting, you should taper off.

Addiction, as I understand it, involves abuse and psychological / social aspects.

My pain doctor said he isn't afraid of me getting addicted, but that any human being, no matter their character or willpower, will become dependent and need tapering off.

As for me personally, I have gone "cold turkey" for weeks because I didn't need it, and didn't feel the slightest physical withdrawal symptom or craving. If I'm not in pain, I just don't think about it.

Now with the higher doses, there is a greater probability that I will feel side effects of withdrawal if I suddenly stop taking it. Not sure what those symptoms are, but I hope not to find out.

No one can accuse Brett Favre of being weak willed or unwilling to tough out the pain. But even he became addicted to vicodin. So no one is immune.

Yeah, it all depends on how you define addiction. Some equate habituation and chemical dependence as the same as addicted. Others separate them by defining addiction to include drug seeking behavior and abuse.

It is all just semantics. But it is important to know that your body becomes accustomed to to opiates rather quickly. It is not a death sentence, but something to respect and understand.

Jan Smiler
I grew up with a family member addicted to prescription medication so I know how that game can be played. This is why I wait until I am in pain before I take pain medication.

My pain fluctuates. I feel for people who are in chronic pain and need to keep a constant level of pain medication in their system because their pain never lessens. When I think of pain clinics I think of those folks.
I am not dependent on norco. I have 2 scripts I still have not filled for the past four months. I am in a lot of pain but I just don't like taking it. I only take it when I am really really bad. So maybe one every other week lately. I could take it daily and feel so much better. When I do take it, I think to myself, "Oh this is what it feels like to not hurt".

Every doctor is different. In Texas I had no luck getting pain meds. My GP would not give it to me and said he could get fined 10k. I called my surgeon back in Florida and told him I had possible c.diff and wasn't doing good that I needed flagyl until I could get tested and get vanco, he called in Norco for me, across state lines. I was always told doctors can't do that. Cleveland clinic will only hand me a paper script and you have to have an appointment to get it.

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