Pain Management??

The following response was sent to me when I commented about how many AIDS patients, and others, I know are being required to enroll in pain management courses to determine whether or not they can continue pain medications. Bob's response is a very sad commentary on challenges heaped on top of the daily lives of those suffering debilitating pain... Link to article.

Thank you, Michael.

I'm a long term AIDS patient in Seattle (Dx:1991) and have lived w/increasing anxiety for the last 6 years about my 20 year daily use of prescription oral morphine @30mg TID (90mg/day) which is just under the 100mg/day limit that GPs/Primary Care MDs can prescribe. Above 100mg/day, oral morphine requires a Pain Mgmt. Specialist since 2010. The younger ones have a different (even punitive) training/perspective/experience than older ones. (I'm 63.)

I had severe/overlapping chronic "shingles" (h.zoster) on my face/scalp 1994-98 and still have ongoing nerve pain there and elsewhere. After a year of oral morphine at 90mg TID (270mg/day), I was moved to large doses of Fentanyl patches, 3x100mcg/hour x3days for 1.5 years (1995-97) and then to 11 months of end-of-life IV morphine (1997-98) averaging 30mg/hour. New neurosurgery in '98 reduced the pain significantly and I went back to oral tablets. My pain hasn't been managed well for the past 3 years as my condition has changed but I've avoided going to a PMSp about increasing my dose. I now have an appointment scheduled and feel some dread about it, based on my previous experience with a younger PMSp in 2010. It should be a conflict of interest to have the same physician in charge of a patient's pain management also in charge of unwanted weaning of opiates in long term patients. And while it is a shame this doctor essentially drove his patient to suicide, I reserve the right to choose the same route if this country's laws drive me to that level of unmanageable pain. I've been there before and won't go there again.

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