Question
Hello Patricia,
I'm hoping you could advise me. My elderly aunt lives in New Jersey and has been suffering with chronic pain for over fifteen years. She was under the care of a pain management physician who prescribed Fentanyl 100 mcg. patches to be applied every two days. She was on this regimen for five years. He abruptly decided to leave the pain management field and gave her thirty days notice. He recommended another pain management doctor who took over her care. This new doctor, however, wanted to bring her down 25 mcg. each month until she was completely off the medicine. She agreed to try this, and was able to successfully drop to 50 mcg every two days. When the dose was lowered below this, her pain became too severe. The doctor has said that he doesn't want to prescribe Fentanyl and that none of his other patients use the drug. He continued seeing her for three additional months and prescribing the 50 mcg. dose, but now will not return phone calls.

She has tried reaching out to social service agencies, her primary care doctors, and no one will help. It seems the pain management doctors in NJ (at least near where my aunt lives) are simply unwilling to acknowledge Fentanyl and that it is the only drug that has ever worked for her chronic pain.

I want to help her, but I don't know how to proceed here. I know if someone goes to a doctor requesting a certain medicine, it looks suspicious. But when that medicine is the only one that works, why deny it? Regardless of the outstanding issue about pain medicine abuse and so on, my aunt requires this medicine to function some kind of normal life. She and I need help here. If you can offer any helpful advice, it would be so appreciated.

Answer
Alex,
Until I hear from you, I found this listing of Pain Clinics in the NJ area. This may or may not help you. It certainly does sound as if she needs a different doctor. It makes no sense to me why this new doc would want to reduce her Fentanyl so drastically. Anyway, here is the list: and I hope to hear from you soon. You may even consider taking her to a physician in New York, if its not too far for her.

CLICK or go here: http://www.ucomparehealthcare.com/drs/new_jersey/pain_management_physicians/














Alex, I hope that my first web site offered you a little bit of hope for your aunt. I have known about them, Action Against Pain, for over ten years. They are extensive, and offer several options for folks whose pain is under-treated. Thankfully, within the last 7 years legislation (which has varied from state to state) has taken place which requires nurses and doctors to grade a patient's pain on a 1-10 scale. It is actually unlawful for a doctor to under-treat a patient's pain, but it still happens often, as you have seen. Where I live, NC, Pain Management Clinics work closely with their patients to treat them for pain. Patients are required to sign a CONTRACT, but it works both ways. While it protects the doctors from fear of giving too much medication, and having a patient in danger of ultimately over-dosing, it protects the patient, and as long as the patient adheres to the contract they will be properly treated. The contract basically states that the patient agrees to not seek pain meds outside of the particular clinic, and to report any ER visits or meds prescribed on an emergency basis by dentists or emergency doctors. I see many patients treated with morphine or even Fentanyl, so I am not sure why her physicians are leery on prescribing that. Are her physicians actual "pain management" doctors? These are often physicians who are also board certified in anesthesiology as well as pain management, at least that's the way it is in my state. If not, then please consult her primary doctor who can give a referral to a Pain Clinic. I realize that laws vary from state to state. I sent you that web site as soon as I got your question, because I needed some time to do a little research. I hope you did reach out to someone from that earlier web site. I am also including another one, below, which, although they can only offer support and suggestions, you may find some answers from them.
If you would like to email me back and give me the location and city where your aunt lives, perhaps even the name of her previous physician, I will attempt to look up options for her in NJ. I don't mind doing that, as this is one of the reasons I volunteer for this service; I do not like to see patients neglected and/or pain or discomfort not treated properly. Please continue to garner help and support from Action Against Pain while you peruse the site below, and send me any further information you wish. I will certainly exhaust all possibilities from my end. Until I hear from you again, Alex, I am here for you and your aunt. -Patricia

CLICK or go here: http://www.medhelp.org/posts/Pain-Management/Pain-Medication-Problems/show/17252