Dismissal from The Pain Clinic

It’s hard to describe what it feels like to be dismissed from a facility I’d been part of for over four years. Dr. Smith administered steroid injections, he prescribed my pain management protocol and above all — he was approachable and humorous. Once he remarked “You’re the only patient I have that knows how to read, there’s no one to show it to” when I tried to comment on a New York Times article I’d recently read about how to rate pain. I considered my relationship with his staff to be above the cordial receptionist-nurse to patient repartee.  We chatted often about family and life in general. Dr. Smith’s nephew was a massage therapist, with a massage business in the pain clinic office, and I’d often availed myself to his services — trying to loosen up the muscles in my neck. A half-hour massage was $35, cash, and apparently Medicare paid for part of it but a full hour was not covered at all and cost $60.

Information from the NC Medical Board on prescribing pain medications, pain contracts, and ethical responsibilities as well as licensing requirement.

One particularly important paragraph that apparently did not apply to my pain clinic:

Information obtained from the CSRS should ideally be used as an intervention tool to improve patient care, not to exclude patients from care. Although not currently considered the standard of care, I believe routine use of the CSRS should be a part of the practice of any physician who prescribes controlled substances for chronic pain. As with all assessment tools, data from the CSR system is not infallible and should not be the only factor considered when making patient care decisions.

Over the years with Eastern Physical Medicine & Rehabilitation I’d received left and right hand carpel tunnel hand splints, a $795 TENS unit (Medicare did not cover because the paperwork for the device was incorrectly coded. Fortunately, Medicare also sent a letter saying I was not responsible for payment of the device.) The coding problem persisted throughout my visits there, often finding a bill of thousands for injections or devices when I checked in and the receptionist requested my minimum payment, then seeing the total due reduced to a manageable amount by the next visit.

–>not online yet(Click here to read a Controlled Substance (Narcotic) Agreement). If you’ve never read one, let alone signed one, it’s interesting to note what patients go through to get pain medication. The promises they make, the requirements placed upon them. I was thoroughly humiliated the first time one was presented to me for my signature, but the nice nurse lady said, “Oh, this isn’t about you, honey, this is for the other people … we have people here on meth!”

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Once the full brunt of what was truly a betrayal by Eastern Physical Medicine & Rehabillitation and Dr. Smith became obvious, I knew what I had to do. By researching NC legal statutes, it became clear that one must send a certified letter to the clinic stating they were no longer to be considered said patient’s pain clinic. Yes, legally dismissing them from service, stating the pain contract with Eastern Physical Medicine & Rehabillitation was no longer valid. The 50 mile round trip to Greenville could be tedious, so I found a new internist locally. My first appointment was in four months.

Then it hit me. No more pain meds. No more scripts. Four months until I talk to someone about my pain.

Whatever Oxycontin and oxycodone I had at the time — that was it. I counted out the 40mg. Oxy’s. There were 12 left — figuring I could half them and take only one a day and up my Lyrica to 150mgs twice a day instead once. Then it hit me again. The reality that I had to withdraw from Oxycontin and all pain meds by myself.

This started an internet search for information. Rather than rage at my fate, withdrawal became something I could do. Seeing myself sitting on the bed, gut pinched, and syringe at the ready — I knew I must do whatever it takes to get off the stuff — or, as Larry would say: “there ain’t no question about it”, it could be done. Hell, I’d survived worse — I thought. Divorce, death, quit smoking, moved many times … and so much death. My sister, brother, mom, dad … what can be worse than that?

First things first. I called both my daughters to tell them what needed to be done. Then I told my husband. It was truly a “Whoa, are you serious?” moment for them all. No one doubted my sincerity. No one doubted my ability to “get off” Oxycontin. The concern centered around my ability to handle the pain.

That’s when the real story begins. My withdrawal and my method for doing so. After considerable online research through forums and pharmaceutical company information, I hit upon the Thomas Recipe.

Next post will contain the entire Thomas Recipe and the effects of Opiate Withdrawal. Tune in tomorrow…

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I will provide a copy of the “Vidant Internal Medicine of Washington NC Controlled Substance Narcotic Agreement” on a Page in this blog in the future.

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