Question
As a RN, you know how pervasive and awful pain can be. My wife suffers from Chronic Myofascial pain, spine and disk degeneration, panhypopituitarism, Osteoarthritis, and a handful of similarly painful diseases and disorders.  She finally found adequate relief 4 years ago with a combination of diet, yoga, Reike, meditation and high-dose/round the clock Opioid analgesics.  She has had the same GP for 10 years and he knows only too well how disabling her diseases were before and after her current treatment plan.  At her last appointment her Dr. said he was requiring her to see a particular pain mgt. Doctor with whom he has already discussed his goal of getting her off of his "books" as she is a liability because of the meds she takes.  She doesn't want to change anything, she manages the side-effects successfully and she has not had any incidence of misuse or diversion, etc of her meds.  So, she fully expects this pain mgt. doctor to recommend drastic change and she's been advised that even seeing this other doctor or getting Rx's from him could be construed as a violation of her Dr/Patient agreement.  That same agreement says that no changes will be made unless mutually agreed on or if medical necessity warrants.  I hope I didn't say too much, I am looking for a way to make her Dr. cease and desist this attempt to push her away which will undoubtedly cause her enormous pain and stress, which I fear will damage her.  can you tell me how a patient who has the need for a certain medicine and has already received it successfully for many years can resist this kind of action?

Answer
Todd

Thanks for your question. I notice you mentioned an RN, and I just wanted to be clear that I'm a psychologist, not an RN or a medical doctor.

This sounds like a very frustrating situation; it's such a long process for many people to get to the point where they have a working plan for pain management.

I didn't quite understand the part about her seeing the other doctor and that violating the doctor/patient agreement. She can see whoever she likes as long as the doctors are allowed to communicate with each other and know what the plan of care is.

I don't know what has prompted her current doctor to decide to refer her out after so long, I have heard that a lot of doctors are nervous about being under scrutiny for prescribing narcotic medications.

This boils down to a case of you and your wife advocating for her care, whichever doctor she's seeing. She has a right to proper treatment for her pain, and this has been confirmed by many oversight bodies, including JCAHO (Joint Commission for Accreditation of Healthcare Organizations). Talk reasonably and "go about it the right way," but don't bend from the position that you expect her to receive adequate treatment. Any changes should have some rationale that makes sense to her.

Hopefully, reason will prevail. You do always have the option of asking for another opinion. If your wife is covered by insurance, you can contact a care manager at the company to express your concern and ask for assistance or referral to another provider.

Hope this helps some. Best of luck to you both.

Barry Hughes, Ph.D.