Medliorate

Improving medical students

Chronic Pain Sufferer or Faker?

Posted by medliorator on June 5, 2007

From Chronic Pain or Drug Addiction by BENJAMIN BREWER, M.D. [The Doctor’s Office, WSJ.com]

Doctors are often accused of not adequately treating pain and being insensitive to patients’ needs. But they also have found themselves prosecuted or disciplined by licensing boards for prescribing too much pain medication. Trying to find a balance can be tricky.

 

Multiple calls to my house outside of office hours for pain meds is a red flag for a patient with a drug problem. So is using extraordinary measures to work around my on-call partner. I’ve seen both of these warning signs before.

 

Sometimes what patients really need is a drug-treatment program rather than a steady supplier for their Vicodin scripts. They doctor shop, and often come from a distance when every doctor in their own community and their local E.R. has wised up to their activities.

 

Patients with prescription-drug addiction seek narcotics by feigning or magnifying common ailments like chronic daily headaches, a bad back or chronic abdominal pain. They complain of pain from disorders that often can’t be objectively verified, and they often ask for their drug of choice by name. They claim to be allergic to essentially any pain medication that can’t give them a mind-altering buzz. Drug seekers tend to tell lies about their past evaluations and activities.

 

Having the old records is the key to the real story. A review of one patient’s records showed she had requested a refill of her medication after “her cat knocked it over in the sink.” She had told the same story to three different doctors over the span of five years.

 

Patients who call the office after a few days claiming intolerance to a drug I just prescribed are often looking to get an extra script of a similar drug. It worked the first time, but now I’m wise to the ploy.

via Kevin, M.D.

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