According to my local newspaper, the CDC (Centers for Disease Control) has issued new federal guidelines “designed to reshape how doctors prescribe drugs like OxyContin and Vicodin.” The CDC is urging primary care physicians to try physical therapy, exercise and over-the-counter pain medications before turning to painkillers for chronic pain.
Oh, I wish it was that easy. Very few physicians–actually none that I know, prescribe narcotic pain medications flippantly. But visits to the physical therapist take time and these need to be approved by the third-party payers before hand. Then, they’re often limited to only a few visits anyway. Exercise is another problem when you’re already busy living life and hurting so badly. I know how hard it is for me to incorporate exercise and I’m completely healthy.
So me and many of my colleagues are suddenly looking over our shoulder every time we write a prescription to ease pain and provide comfort for our chronic pain patients. And unfortunately, no one has yet invented the “painometer” to determine the level of pain someone is actually experiencing. I don’t know if Bob really really hurts or if he just hurts like the rest of us.
Interestingly, I had a patient the very day this article came out who has been a chronic pain patient of mine for the last 15 years. He has had 3 surgeries on his lumbar spine and has had no significant improvement that would merit a fourth. He actually asked me without prompting to decrease his pain medication from 30 mg to 20 mg. He stated that he did not get any significant increase in help on the higher dosage. He would rather use a lower dosage to minimize his risk of increasing addiction.
I wrote a prescription for the lower dosage and he presented it to his pharmacy of choice. What do you think happened? His pharmacist and insurance company actually refused to fill the prescription because it was a different dosage and it would have to be reauthorized through all the powers that be.
So back to my office he came for another prescription. To avoid weeks of more paperwork, the headache that this process takes, and the usual rejection anyway, we rewrote it for 30 mg and said piss on it. So much for Ivory Tower medicine.