ASSIGNMENT 13: The 'pain' of feeling caught in the middle

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(WEAU) – Prescription drug abuse is on the rise, according to the Centers for Disease Control and Prevention. That's why doctors say they have to be careful when prescribing pain killers for chronic pain patients. It leaves some physicians feeling trapped in the middle, between drug seekers and patients who truly need medicine to manage their pain. That's also why chronic pain patients say they feel caught in the middle. They're being questioned as if they are a drug seeker.

James’ Story

At first glance, James Grace seems like a normal guy. He’s a father, a paramedic student and a veteran. But what you don’t see is his chronic pain. If you take a look at his dresser where pill containers are laid across, you’ll find prescription pain medications. He has to take around nine pills a day.

“I got two bulging disks in my lower back and I got a tear along the sheath in my spine and one pinched nerve and that was from my tour in Iraq,” said Grace. He said he turned to the Veterans Affairs clinic, but doctors there told him to try physical therapy. Physical therapy wouldn’t manage his chronic pain, he said.

The VA eventually questioned him, said Grace.

“I started off with extra strength ibuprofen and worked my way up and they just kept on saying what are you doing with all your medication, where are they going and are you getting them in the mail, are you taking them all or are you selling them,” said Grace.

That’s when he stopped going to the VA to treat his pain. He said it was a feeling of frustration; After serving his country, denied the help he was looking for.

Grace however isn't alone.

Vanessa’s Story

UW-Eau Claire student Vanessa Percy is a theater major. She says her chronic pain makes every day a challenge.

“I have to think about how far I’m going to walk, those kind of things and how much energy I’m going to waste,” said Percy.

Three years ago, Percy was diagnosed with Cushing syndrome. Her body produced high levels of the hormone cortisol, causing extreme pain in her legs.

“It messed with a lot of different things in my body, including my muscles (which) wasted away,” said Percy. She's since had surgery, but other problems soon surfaced.

“Slowly but surely my chronic pain is getting worse even though they thought it was going to get better,” she said.

Percy said the only thing that helps her chronic pain go away is a prescription medication called dilaudid. It's an opioid pain medication used to treat moderate to severe pain. A drug doctors are sometimes hesitant to prescribe, especially if the patient insists on dilaudid and refuses other medications.

“It's a very high up pain killer, for some reason that's the only thing that touches it,” said Percy. “Whenever I’m in pain, that's really what I need but I get afraid of asking doctors about it because I’ve been accused once of perhaps taking it all the time,” said Percy.

She said it's come to the point where she can't tell doctors the extent of her pain. She said it’s difficult to get doctors to understand how much her chronic pain is hurting her.

Patients Caught in the Middle

Dr. David Junker, MD sees pain management patients at Marshfield Clinic. He said chronic pain patients like Percy and Grace will often feel caught in the middle because the number of abusers keeps rising. Both patients in legitimate chronic pain and patients who are “pretending” to be in chronic pain will be questioned in the same way.

“Patients are frustrated who have truly legitimate pain and have to process and take urine drug screens and you know, often they will feel kind of like they're criminals when you ask them all these questions about if they’ve abused medications. Those types of things can certainly make people more defensive but it’s something we have to do in today's society,” said Junker.

Both Grace and Percy said they hope doctors can spend more time with each patient before deciding whether or not the patient truly needs prescription drugs to manage the pain.

The Veterans Administration in Minneapolis said its concern is always safety and it encourages other forms of therapy when appropriate.

Doctors Caught in the Middle

Prescription drug overdose death rates have more than tripled since 1990 in the United States, according to the Centers for Disease Control and Prevention.

That’s why doctors say at times, physicians are the one's caught in the middle between patients who want their hands on pain killers for abusing or selling and the patients who are truly in chronic pain.

The CDC also reports for every one overdose death of prescription pain killers, there are 825 people who abuse it.

Junker said determining someone’s pain level is by far the most challenging.

“There's no test we can give them. We can't hook you up to a machine and say 'oh your pain is 10 out of 10 today', so it’s a very subjective complaint. It’s all based on the patient's experience,” said Junker.

He said the bottom line is doctors have to believe what patients tell them. But it's a scenario that can sometimes trap doctors like him in the middle.

“It's hard because when people hurt, you try to put yourselves in their position. It's hard when you're compassionate and you want to help people. You do get caught in the middle of that and maybe previous experiences where you know you've had patients who had been selling your prescription on the street or hurting themselves or overdosing,” said Junker.

Drug seeking patients will often come up with excuses for their chronic pain medications, like getting dumped down the sink, falling into the toilet, medications were stolen or taken, or losing the pain killers somewhere.

Junker said drug seekers will often turn to 'doctor shopping' to get what they need. These are patients who will go into multiple emergency rooms on different days of the week with pain episodes. They’ll look for narcotics from the dentist or from other providers and health systems.

“We want to look at every patient as believing that they're in pain,” said Junker. “So really the question becomes, based on everything that we're seeing - their exam, their story, their lab studies, their x-rays and MRI’s, does it makes sense? Could this patient benefit from a narcotic?”

Doctors will also determine if a patient is a low risk, moderate risk or high risk patient.

“If they're high risk, it doesn't mean we don't prescribe narcotics. It just means we're going to have to have you come in more often, maybe every week, we're only going to give you a prescription a week at a time. We're going to see how this goes, we're going to do pill counts, we might do more frequent urine drug screens, so all that kind of is going to dictate how close you're monitoring that patient,” said Junker.

Dealing with Prescription Drug Abuse

Psychotherapist Brien Gleeson specializes in addictions at Mayo Clinic Health System. He said prescription drug abuse is a problem he sees locally and nationwide.

“One of the real concerns is not only that a person might become addicted to the drug itself but another level of addiction comes from the fact that is fairly lucrative to sell. An Oxycontin or Vicodin can bring $8 to $10 at a public school a piece. You got a bottle of those sitting at home, that can be pretty tempting,” said Gleeson.

Gleeson said the home medicine cabinet may be the number one place for young people to get their hands on prescription drugs, whether it’s in their own home or a friend’s home.

He said for those who are addicted to prescription drugs, treatment begins with the help of a friend or a loved one who is concerned.

“I know a good number of people today who are in recovery not so much because they took the first step but because of a concerned family member did,” said Gleeson. “So a lot of times it can begin that way.”

Gleeson said the variable that makes the biggest difference in success is how intense and how long the treatment is.

He said the first step towards treatment is calling the behavioral health department and make an appointment to learn more about resources. And if a child does need to go to treatment, parents should also go too, building a support and accountability system.

Junker said he doesn't know if there's an answer to ending drug seeking, but there have been other solutions like the new electronic prescription monitoring program. Doctors are able to look up a patient in an online data base and see when and where a patient's prescription has been filled, which could put an end to doctor shopping.

Junker said doctors and patients can look at other ways to treat pain, other than narcotics.

“We really are finding out that narcotics aren't always the best thing. Narcotics are great pain medications, but there’s lots of others modalities, from medications to injections to psychological help. A lot of chronic pain patients have depression, anxiety, all that goes along with eating, dieting, exercise, stop smoking,” said Junker “So all that goes into managing chronic pain. It’s really looking at the whole person when we treat it.”

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