When You're Labeled A Drug/Opioid Abuser...

Reader Question: What if your records say "DRUG/OPIOID ABUSE" over and over for two years? There seems to be an instant ban sent to all pain physicians once this happens. I am trapped in a "drugs for drug abuse" clinic because this is the only source for the partial opioid agonist that stops the nerve damage pain in my legs but cannot help my scoliosis pain. After 35 yrs. of pain my records - the best ones burned - are too long and have no "proof" that anything is "seriously" wrong.--Anonymous (Original Post here)

What To Do When You're Labeled A Drug/Opioid Abuser
Answered by Heather Grace

First, I'm so sorry you're dealing with such a serious issue. It can be hard enough to find effective pain management if you're the average chronic pain patient. This is a tough spot to be in, as you've already discovered...

Any patient in your shoes would need to focus even more intently on the advice given in the article, "Tips & Secrets: How to Find a Good Pain Management Doctor ."

It becomes especially important to ensure physicians see that you are suffering from chronic pain. How do you do this? It may be useful to provide prospective physicians information on the OBJECTIVE signs of severe pain: http://pain-topics.org/pdf/Tennant-PainSigns.pdf. Medical professionals often refer to pain as the 5th vital sign, but how many actually look for it in their patients? Why not give them their own copy of this article, to keep? (Personally, I think it's groundbreaking information. So many doctors believe pain is a subjective complaint, when in fact, there are many signs!)

Now, let's address the label you received: What is the reason you were called a DRUG/OPIOID ABUSER? Was it a legitimate label--did you have a problem with substance abuse? Or, was it perhaps from a doctor who misunderstood your behavior, classifying you as an abuser for signs that were actually pseudoaddiction? Remember, patients who are UNTREATED or even those UNDERTREATED can be very confusing to physicians who don't truly understand pain!

Here's more on pseudoaddiction: http://www.addictionmanagement.org/Pseudoaddiction%20versus%20Addiction%20in%20a%20Pain%20Population.pdf. You may want to bring this to a doctor's visit, as another piece of information for the doctor to keep.

More on Pseudoaddiction
Many doctors don't know enough about pain. They can be completely in the dark about pseudoaddiction, or dismiss it as an excuse. It's very possible these physicians have dismissed patients needlessly because of it. I wish there was better education about this condition on both sides. When there's not adequate pain relief, pseudoaddiction is just as scary for patients as it is for doctors. Neither may be quite sure what to make of it, which only makes pain management that much more elusive.

Now let's discuss your records: I know it's frustrating to believe that the doctors you've seen aren't writing down any information that is useful to document your history of pain. However, you should STILL bring all available documentation you have regarding past treatment of scoliosis and associated chronic pain/nerve pain. And, for any lost records, request copies from those doctors/hospitals. You will especially need to provide: info on the diagnosis/treatment of scoliosis and your pain, as well as records for all care SINCE the label. Also be prepared to explain the classification of "addict" from your viewpoint, how your pain level has been since then, what you've been doing to treat pain since, etc.

Keeping a pain diary is vitally important, even if you start today. What to include: What's your pain at it's worst for the day, and at the best? What's the average pain level for the day? Take a paragraph or two to describe how you felt and what you did about it... how you tried to lessen the pain, even if it was trying to fall asleep.

Though it feels like you have no "proof" of a "serious" problem, this is not entirely true. Having a stack of past records with you is impressive. Most people don't bring much evidence of past treatment. Your past treatment was extensive, so why not let prospective doctors see this? In your case, this helps combat the negative label. These records show you have stuck with it--seeking treatment for 35 years. This is proof YOU know something's wrong and aren't giving up the quest for appropriate pain care. You didn't drop out, as an addict might.

Try to be as detailed as you can when putting this together--it can't hurt. You might want to organize your files using tabs for "doctors records" vs "diagnostics" or "hospital stays" and organize everything in order of year, much like you see in medical settings.

Showing consistency means something. There are other ways to prove yourself than a series of doctors who may not understanding your pain. Such as: your own 35-year history, concisely worded on a single page front/back if you can. List of all treatments (prescription, non-prescription, specifics of physical therapy, creams, whatever) you've tried for the pain, all docs you've seen, all surgeries, xrays/MRIs and other diagnostics(copies if you have them), number of years in treatment, date of diagnosis, etc. In addition to the records, bring all pain diaries. Bring all info on YOU/your illness that you can. Even if you only show him the overview pages, that stack of data is proof that you are not a flaky person. Not just a drug-seeker. (Don't hurt yourself! You may want to get yourself a cart that holds paperwork--they sell these at office supply stores.)

Bring all your info, as well as an advocate... a loved one who believes in you and knows how much you desperately need care. Let them chime in from time to time, explaining their concern for you--what specific issues they've seen, etc. And, even if you are having a tough pain day and feel awful leading up to your appointment, pay special attention to grooming: shower, clean clothes that have no signs of wear, neatly done hair, etc. Same with your advocate. You are representing yourself as a patient in everything you do, leaving that doctor with no doubt in his mind.

Be prepared for a skeptical attitude from some doctors. Pleasantly answer all questions, even if they seem overly intrusive or harsh. Never act out or show anger--show that doc you want his help and are prepared to work for it. You want to prove yourself 100%. You will undoubtedly be asked to sign a contract regarding appropriate medication use. And, you will also likely be tested at every appointment for compliance, typically using a Urinary Drug Testing (UDT). If at any point you get a result which puts your honesty in question, your behavior at that point is key. Explain you believe there must be an error. Ask immediately and calmly for a BLOOD TEST. (UDTs are problematic and can be inaccurate.)

HOW/WHEN TO DISCUSS THE ISSUE:

When making an appointment, it is best not to bring this issue up. Instead, wait til the visit. And, be prepared to bring this up as part of your medical history, but don't make it a huge deal. Tell the doctor whatever the situation is, in the same tone as you told all other details. Do so at a point when you've built a decent rapport with the new doc.

I'd do so during a brief overview of care in the last 5-10 yrs. After you've told him all the history leading up to this two-year period, you tell him the situation calmly. You might say something like: "Then, I saw Dr. X. Unfortunately, he did not understand the extent of my condition. My treatment under Dr. X did not adequately manage the pain. Because I was in so much pain--I became desperate, calling him several times in between visits. I explained to office staff that it was an emergency and I needed medication asap--more than he had previously prescribed. I believe this is why I was given the label 'opioid addict' when in fact I was exhibiting signs of pseudoaddiction. As I've explained, I have severe nerve pain from scoliosis."

Be sure to let the new doc know what you've had to do to attempt pain care since then. Continuing to seek care at a drug abuse clinic because it's the only option you could find? In my book, that means you are desperate for pain care and want help any way you can get it. This means something too. You need someone to just hear you, understand you, help you. Be open and honest with any prospective physician, but always represent yourself in the best possible light. No emergency calls. No lost pills. No suspicious behavior of any kind for any reason.

I believe you will find someone who will help you, because I have personally seen it happen. A woman with severe pseudoaddictive problems was self-medicating with alcohol and hard drugs. She was given a chance by a doc I know. If she can, I have faith that you can as well.

You haven't given up hope and that's huge. Keep fighting for care til you find someone who will listen. If you have a tough time finding a doc in your area, please feel free to contact me for further assistance on Twitter: @IntractablePain. Best wishes, I know it's tough! -HG

Objective Signs of Intractable Pain: Constant Severe Pain Symptoms ARE Diagnosable

by Heather Grace

Do you have severe, persistent pain? Have you been diagnosed with a serious pain-related illness like Reflex Sympathetic Dystrophy, Adhesive Arachnoiditis or Intractable Pain? Most pain patients find it very difficult to find, and maintain, good pain management. There are many reasons for the problems surrounding access to quality pain care (that is a whole separate article). One of the easiest issues to address comes down to the ability to tell a real pain patient from a possible fake.

It's long been believed that pain is a subjective complaint--meaning that only the patient can really tell you what is going on. Surprise! That's simply not true! Forest Tennant, MD, DrPH, an Intractable Pain specialist for over 35 years, has used what he's learned in his practice to help other physicians better understand pain. In fact, he's written over 300 articles on pain. In a ground-breaking paper, Dr. Tennant highlighted the key signs of severe pain.

Yes, you read that correctly. There are specific signs that a doctor can utilize to diagnose and treat pain sufferers--just like they use in diagnosing any other illness. Pain does indeed have objective signs!

Sadly, even the majority of doctors don't know this is possible. It's perhaps the greatest flaw in the curriculum at medical school. Pain is simply not a focus of a great deal of study. Despite the fact that pain is one of the chief complaints patients have when visiting their physician, most doctors just don't have enough training in its diagnosis and treatment. Of course, that doesn't help pain sufferers get the care they need.

So, what can we do to help doctors understand the plight of the pain patient? It's simple, really. This information must be spread, far and wide. Whether you are seeing your family doctor, an orthopedist, a pain management physician or any other medical professional, please help them further their education on pain: provide them with Dr. Tennant's ground-breaking paper! It's time that doctors realized that pain is something that can be objectively diagnosed. All you need are the right tools. Here they are! From the article:

Using Objective Signs of Severe Pain to Guide Opioid Prescribing.
Pain Treatment Topics, June 2008.
by Forest Tennant, MD, DrPH

Online at: http://pain-topics.org/pdf/Tennant-PainSigns.pdf

How do doctors ensure they are treating only true pain sufferers? Thankfully, there are many ways to tell. Uncontrolled severe pain can be identified by objective signs that help practitioners to differentiate between drug-seekers and relief-seekers. This sort of pain "produces more objective physical evidence of its presence than does the average case of diabetes or coronary artery disease."


Persistent pain that is either untreated--or even under-treated--will produce physiologic responses. These include: changes in pulse rate, blood pressure and pupil size. Other signs include: cold hands/feet, sweating, body asymmetry, sensory avoidance, muscle atrophy and seeking positional pain relief. What does that mean? Please review the charts on this page for the nitty-gritty on these signs.


The best news, of course, is that astute healthcare professionals can use these measures to objectively identify pain patients. No more guessing, no undue stressing. The pain rating scale is not the only tool in a physician's arsenal. While it is helpful to request a patient's rating of their own pain, on a scale of 0 to 10, doctors can compare this information and other complaints put forth by a patient against the objective measures. This strengthens the therapeutic relationship, while also ensuring doctors are relieving the suffering of pain patients in their care.


Blood Tests: More Objective Evidence of Pain

Hormones. Further evidence of severe, persistent pain can be found in blood tests. Doctors should look for changes in hormone levels: stress hormones, testosterone, progesterone, estrogen. Both men and women will have readings that are out of the norm. Depending on how long a person has been dealing with pain (early on vs. years into it), the adrenals, for instance will either produce very high readings or very low, respectively. Stress hormones work over-time, trying to combat what is going on in the body. Eventually, however, the body can no longer cope and stress hormones are depleted. All hormone levels go out of whack. Signs can be seen in the patient, such as changes in volume of body hair, irregular menses in women, etc. These are questions that can be asked during an exam, to help clarify possible hormone issues, prior to testing.

Drug Testing. As a pain patient, expect your doctor regularly test you, to ensure compliance. This basically means, your doctor wants to know you are taking the medication you have determined helps relieve your pain--and you are not taking anything else that you have not discussed with him. (Either prescription or illicit drugs.) This may be blood tests, however, urine testing is far more common. Perhaps this is because the results are available right there in the doctor's office, but know that this is controversial. If a urine screening comes back with unexpected results, request a blood test to verify the data.

It's a sad fact that this is necessary in pain care, but because of the DEA and State Medical Boards, doctors are using this to protect themselves. Yes, it's true--this doesn't happen in any other care of any other serious illness. It's almost not in the doctors' hands anymore--it's a necessary evil. Just know it's happening all over; you are not being singled out. This is just one more way a doctor can ensure he/she is treating on pain patients, and not people who might try to sell their medication and/or abuse other substances. A pain management physician never wants a drug addict or drug dealer to enter their office. However, they can and they do. If a simple test means I have access to pain management, which allows me to be a productive person, well, I say, why not? After all, I've got nothing to hide! Nor do any other pain patients. Now, it's just another thing on the list of 'things to do' at the doctor's office. So relax, provide your sample, and move on with your life.


A good relationship with your doctor is key. So long as you are a pain patient and are not keeping anything from your doctor, all of the information here will strengthen the therapeutic relationship. Trust is a huge part of being a pain patient. You must prove yourself, and continue to prove yourself, throughout your care. It shouldn't be the case, but sadly, in this climate of hyped up Oxycontin addiction and overdoses splashed in headlines, doctors have to be vigilant. If they weren't, they wouldn't keep their doors open very long! Be upfront and honest--always tell your doctor what you think might help, and he/she will share his ideas with you. If you aren't getting good pain care, keep looking. Good doctors are out there, even though, admittedly, they are harder to find than they should be!


Differences from One Patient to the Next

Patients may wonder whether these objective measures may be problematic for them, given the differences in measurements from one patient to the next. The answer here is simple. When you visit a new pain management physician, provide him/her as many records from prior doctors as you can. If your blood pressure tends to be very low, then perhaps what appears to be a 'normal' reading is actually very high. Conversely, if you already had high blood pressure prior to the start of your serious pain, you can provide a pain doctor with evidence of this. Most people with high blood pressure are treated for it with hypertensive drugs. If your blood pressure was high and it subsequently increased, this will be noted in your files. So will any increase in blood pressure medication, since your pain began. This will help a physician understand that the blood pressure rating may be low due to medication, not because you aren't in pain.

Additionally, these ratings will change, over time. Once a patient receives the appropriate medication, he/she will get some degree of pain relief. If you are getting medication that helps, your blood pressure/pulse and other signs will improve, because you are getting the pain under better control. It is also important to note that even if patients are not getting the pain relief they seek, either one or the other of blood pressure or pulse can be within normal range.

In my case, I felt immediately at ease with my doctor, after our first visit. I think my pulse was still very high for the first several months, but my blood pressure went down fairly quickly. I finally felt like this was my answer--this doctor could help me. The stress I felt was being combated by the mere fact that I trusted this man to help me. Less stress often means better pain control. Additionally, patients who are generally getting good relief but are having a very stressful morning, fighting traffic, etc, may have higher than normal readings, as well. It is best for doctors to always give the patient time to calm down from any such issues, before they are screened for blood pressure and pulse. This will assure readings that more accurately reflect a patient's true resting blood pressure/pulse rates.

What Does a Pain Patient Look Like?

Personally, during my first visit to an Intractable Pain specialist, I was scared. By the time I saw this doctor, I was literally at the end of my rope. If he didn't have any answers, I was determined to find my own way out of this, even if meant death. It was a very dark time for me, no question.

I had no clue about all of these objective measures for pain when I saw him, I was just sitting, trying to fill out paperwork, wondering if I would ever feel like myself again. There was no question that I was in serious pain. I had been on high doses of Vicodin for some time, but it just wasn't managing my pain anymore. There are far better medications out there that don't require patients to take in 3000 mg of acetaminophen per day, or more, as I was for several years!

At that time, many of these signs were present in me. Very high pulse (94, if I remember correctly) and blood pressure was equally high (I don't recall the exact rating, but it was in the neighborhood of 145/110). I don't recall my pupil measurement. Hands and feet were like ice nearly all of the time. I slumped to the right in my chair, guarding my left arm, which was very numb. I could no longer tolerate leaning it on the arm of any chair, no matter how padded it was. At the same time, I kept my back straight, trying to always pick a chair with a high back. If that wasn't possible (as if often the case at doctor's offices), I selected a chair that was very tightly up against a wall; that way, I could lean my head up against it. I scarcely moved my head or neck, trying to stay very rigid. My neck was a mess.

I forced myself to shower, but didn't do much other than comb my hair. No make-up. By the time I'd showered, I was already late. Everything took so long to do, it seemed! Even though it was January, I wore very flat shoes, flip flops, because most everything else was so uncomfortable, anymore. I found that my feet being covered, especially the toes, hurt. And heels, forget it! No matter how cute, 90% of my shoes just collected dust.

Clothes too! I wore loose fitting clothing, but tried to make myself as presentable as possible. I used to dress fairly professionally, as you would expect a Department Manager in Marketing/IT. That was who I was for so long--nearly a decade. But, increasingly, even in the last few years at work, I could not wear my nicer suits, or even nice flowing skirts/dresses, because none of the shoes I was able to wear looked right with them. I struggled to find semi-professional clothing and after a few years of this, I plain gave up. Soft cottons without any pilling were about all I would manage.

Several times, during my visit with the doctor, he asked me to repeat myself. Apparently, I was speaking very softly and didn't even notice it. That's common with neck injuries, he told me. I still am not exactly sure why, but the fact that my surgery was near my vocal chords does make some sense. (They had to go through the front of my neck to do the surgery safely, so I was warned I might never speak again, etc. Luckily that didn't happen, but I often have people asking me to repeat myself, especially people I don't know and am not comfortable around. Weird, but true.)

As he examined me, he noted muscle atrophy and weakness. My doctor took photos of my pain areas. Even I could see the swelling in my forehead and the crease, as I looked at the photos--it was noticeable, though I'd never thought about it before. I have chronic headaches, which are apparently visible when they're nearly round-the-clock! He also noted inflammation in my upper back. It all made sense. It was right there, for all to see, if they would only look!

I often bit my lip, thinking it was a nervous habit. Apparently, it's something people in pain do to distract their nervous system from the pain. I also became very clumsy. That's how I would describe it. Many cuts and bruises, mostly on my legs. I'm not sure if it was the numbness or my body's desire to be rid of the constant pain signal I was dealing with. I was at an 8, 9 or 10 on the pain scale, consistently, before I saw this very knowledgeable Intractable Pain specialist. Apparently, some patients, consciously or unconsciously, hurt themselves, to help their bodies redirect the pain signals.

Important Questions Regarding Intractable Pain

During that initial visit, my doctor asked me questions no one else had asked before--honestly, I was starting to get nervous...

Had I been sleeping? Hardly at all, max of four hours at a time. Even that much was rare. I was exhausted.

What about eating? Not much, but lots of sugary stuff, mostly. Really bad. He nodded.

Did I go out much? See family or friends? Not really. Not ever. I was starting to worry. What did that mean?

Then he asked about exercise. Or if I went out and did anything I enjoyed, at all. No and no.

What did I do with my time? Sit around, worry, try to sleep, watch some tv. Not much, at all.

My alarm bells were going off. It was as if he knew me better than I knew myself! At the same time, I was worried it was something really, really bad. I mean, the pain was bad--really bad. But, what was all this about? Throughout his questions, my doctor was taking notes--lots of notes. Notes make me nervous. Other doctors rarely listened so intently! I started to kind of space out--maybe I was in shock, or maybe I was too worried to think straight, anymore. We were still talking, but I was so consumed with the WHY behind it all, that I didn't hear much else, until he asked this one:

How are your teeth? Grind them? Lots of cavities? Other dental work?

That was it, I lost it, completely. How did you know? I began to sob. He left the room, grabbed a box of tissue and came back. (I suspect, this was also to give me a chance to compose myself.)

When he returned, I had to give him every bit of info, about my teeth. I often gritted my teeth in my sleep--not grinding, but jaw clenched, very tightly. In the past few months, it was as if I only left my house to go to the dentist. Crown after crown. Cavities rotting into seriously bad situations. My first ever bridge. I didn't know anyone who had one of those, except me. I was a dental nightmare!

Based on the exam, interview, photos and all the paperwork, it was pretty clear to my new doctor that I had Intractable Pain, which has some extra symptoms for doctors to look out for, in addition to the subjective pain signs above. Eventually I learned I also had Reflex Sympathetic Dystrophy.

Tough stuff, but at least now I know. And with the help of a knowledgeable doctor who cared to ask the right questions, I have some semblance of a life back. Pain management makes a big difference. Is it the same life I was living before? No. I will always have pain. That's what Intractable Pain is. But, more than that... I am still here, and I am fighting for others with pain, like me.

What Can I Do To Make My Doctor To Understand My Pain Is Real?

Please, share the signs and symptoms of pain with your doctor. Let them know you are not crazy, faking or lying. Your pain is real and they can see the symptoms... if they just know where to look. Print out the brilliant work by Dr. Tennant for your doctor(s), loved ones, fellow pain sufferers you know. Bookmark it, too. It's here: http://pain-topics.org/pdf/Tennant-PainSigns.pdf for all to see!

Change starts with you! Give copies to other people at your doctor's office. Start a movement. Push for the care you need; push for better care, for everyone. The more doctors understand a true pain patient, the more we will all get the pain care we desperately need. Many of the people I know with severe, persistent pain have gone through hell, just to get someone to listen. Isn't it time that era of pseudo-pain care came to an end? Real pain care starts today--with you!

Remember: Pain doesn’t discriminate. It affects people of all races and economic status at all stages of life—from our very young to our elders. Research has also shown that about a third of people who report pain indicate that their pain is *disabling* -- defined as both severe and having a high impact on functions of daily life. Pain is a national healthcare crisis. It is our nation’s hidden epidemic.

The Bottom Line: People in pain have a right to timely, appropriate pain care. And thanks to Dr. Tennant's work, all doctors will be better equipped to diagnose, then treat it.

An Intractable Pain Patient's Guide to Medication Safety

by Heather Grace

The life of an Intractable Pain patient is incredibly challenging. Whether you have Reflex Sympathetic Dystrophy, Complex Regional Pain Syndrome, Trigeminal Neuralgia, Central Pain Syndrome, Adhesive Arachnoiditis or any similar illness, there are a lot of important issues on your plate. Policy-makers, physicians, insurers, and even the media, raise a whole host of concerns for persistent pain sufferers. It's easy to let important things like medication safety slip to the bottom of your "To Do" list. The fact is, there are many precautions you can take, in order to make yourself--and your medications--safer. We've all heard the horror stories. None of us wants to feel as though we need to be looking over our shoulder. Why not be better prepared for common situations? This article should help you do just that! Let's begin...

Strengthening Safety in the Doctor-Patient Relationship
Your physician's most important role is ensuring your have effective pain management. However, medication safety also begins at the doctor's office. My doctor asks me to sign a Prescription Agreement form each year. By doing so, he has a document that states very simply which pharmacy I go to for my medication, their address and phone number. At the bottom of this form, I am asked to agree to go to this pharmacy, and no others, for my pain medication. If for any reason my pharmacy changes, I am also asked to inform my physician.

Every pain management doctor should have such an agreement in place. If any issues arise, the office has easy access to where a patient's medications are handled. Additionally, as of 2010, physicians can also submit prescriptions to pharmacies electronically--even prescriptions for pain medications. The prescription agreement protects the physician, and may also help legitimize the patient's need for prescription pain medication. However, to protect pain sufferers, it's probably best to take this idea one step further.

For a patient's protection, an additional form should be generated--and updated--yearly, at the doctor's office. A Pain Patient Diagnosis form is vital. This should include the date, patient's name, how long they've been treated for Intractable Pain, and should also include an updated list of diagnoses. Additionally, it should contain a statement such as " I, Heather Grace, have reviewed and agree to abide by all rules set forth by my pain management physician, Dr. X. I believe my condition(s), listed above, are permanent and incurable. I wish to be treated by Dr. X, for Intractable Pain, and understand that my treatment involves the responsible use of all medication(s) prescribed to me, as part of my pain management treatment plan." The Pain Patient Diagnosis form, signed by both doctor and patient, is a huge step toward protecting both parties, legally.

For logistical reasons, it would be best to combine these two forms, into a single document, entitled something like "Pain Patient Diagnostic & Treatment Agreement 2011." Why not bring this up with your physician, if they aren't already doing something like this? Updated yearly, such a document should be kept on the patient at all times. For those with implanted medical devices, be sure this is noted on the form. The more protection you have, when dealing with the authorities or TSA agents, the better!

This sort of information is priceless, when it comes to your safety as a pain patient. As soon as you receive these sorts of documents, make copies! If at all possible, keep a copy in your wallet and purse; also keep a copy in your car. For those who do not drive, ask your caregiver or loved one to keep a copy in their car, on your behalf. Make extra copies for when you travel. Ensure you have extras stored somewhere safe, in case the originals are misplaced.


Strengthening Safety at The Pharmacy
In addition to keeping a copy of your diagnostic-treatment documents in your car, provide a copy to your pharmacy each year. This will make them feel safer, providing you with your opioid medications. Then, each month when you pick up your new supply of medication, take an additional step: save pharmacy's information sheets, on each medication. Place all of these, as well as the receipt, in your glove compartment. Include the information from your doctor regarding your diagnosis, and you're prepared for whatever comes your way! Be sure to switch out your medication information, monthly, so that the most recent prescription information is always on hand. If you are ever pulled over by the authorities, it's easy to prove the medications you have with you are indeed yours, and were legitimately prescribed, to you, as a pain patient.


As a pain patient, I believe this makes it safer to carry my medication, in whatever container I choose. Let's face it, anyone with a serious illness has several prescriptions. Carrying all of the original containers, provided by the pharmacy, can prove exceedingly difficult. When you're just going out for a couple of hours, why bring more than a day's worth of medication with you? Because the medication is clearly identified on these prescription sheets, anyone can easily identify each medication by color, the words printed on them, etc. Whether they are in a pill sorter or small pill container, there will be no doubt what medications you have with you, what they are prescribed for, and that they legally belong to you, a pain patient being treated for a legitimate illness. Of course, the laws vary from state to state, and it is always best to carry your medications in the original containers, provided by the pharmacy, whenever possible.

Coming and Going. Pharmacies are everywhere these days. Most are brightly lit and they appear to be a safe place to be. However, more and more, pharmacies are being robbed by people desperate for prescription drugs. Many are addicts; some are dealers. The street value of many medications, unfortunately, would astound most people. When you go to get your medication, just be cautious. If anything appears out of place, don't go in. Wait, and even call the authorities if you suspect a robbery in progress.

When you leave the pharmacy, be even more cautious. Be aware of your surroundings. Don't be fiddling with your purse to find your keys or reviewing the prescription info, with your head down, as you walk to your car. If you want to double-check your meds, do it in the pharmacy. It's also best to get your keys out, before you head for the car. It's these little touches can mean a big difference to your safety! Be extra careful if, when inside, either you or the pharmacist mentioned the names of the medications outloud. It's best to have a good rapport with your pharmacist, and feel comfortable telling them the things that matter most to you. Before the issue arises, instruct your pharmacist that you prefer for them to show you the names of the medications you are picking up silently--by allowing you to review the pharmacy's drug information sheets. This keeps you safer in a place that is increasingly becoming a target of would-be thieves.

Strengthening Safety at Home
We all know how vital opioid medication is to pain management in serious conditions like RSD/CRPS. We also know how dangerous pain medication can be, in the wrong hands. It's a sad state of affairs that we have to worry about our medication, in our own homes, but it's a fact of life these days.

There's a senior community not far from where I live that's had multiple break-ins. Why? Maybe it's because there's a natural assumption that older people experience more pain that the average person and thus, they're more likely to be prescribed pain medication. Vicodin, Soma, Tylenol with Codeine and the like have been stolen from the seniors' homes, with little to nothing else being disturbed. For an Intractable Pain patient, such a theft could be life-threatening. A chronic pain sufferer may take 30 or so Vicodin per month. Intractable Pain patients generally have stronger medication, often in large quantities. So, how do we keep our meds out of the wrong hands?

• Know When/Who To Share Your Information With.
  Though you may feel it is best to share your health information with most service people, in an effort to speed things up, be cautious. Especially when the people you are speaking with have access to your address and may even handle your keys, it may be best to be vague, if you tell them anything. For instance, whenever your car is going to be serviced, give only your car keys to the technician. This sort of thing never seemed like a real potential for problems, but on several occasions, I've told my people at my local car dealership that I wasn't able to wait for the car, because I was in so much pain. All it takes is one crafty person overhearing your conversation to act--and you could be targeted. Even when you are speaking with someone you know and trust, it's a good idea to be aware of your surroundings, and anyone who might overhear what you're saying. For instance, it might be best not to discuss the particulars of your doctor's appointment on the phone to a friend, while a locksmith is installing new locks on the front door of your home. Especially in today's world, exercising caution is a good practice.




• Playing It Safe.
  Many patients I know, including yours truly, have safes. The safe I purchased was inexpensive and it's large enough to hold a month's medications, plus important paperwork. Whenever possible, a wall or floor safe is a patient's best bet. Many excellent safes are available for under $350. You can get an idea of the cost of a good safe online; start by searching for "inexpensive floor safes". If you know how to install your safe, you can save on installation as well. Ask a handy friend--anyone you know with their own set of tools. These safes come with directions; anyone that's handy should be able to install one relatively easily.
  
  For those wanting extra protection, an alarm system is an excellent idea. Some are available without a monthly monitoring plan. For instance, a web site called x10.com has a 19-piece system for under $100. No monitoring plan is necessary--the system calls you if any of the 8 door & window sensors or 2 motion detectors are activated. It sounds like an excellent plan, though I cannot vouch for it's effectiveness. Similar systems are sold at stores like Fry's Electronics, and other electronics stores. However, any of the big companies with alarm systems that you see advertising all over do not have these sort of self-monitoring systems. Most require the monitoring for $30 per month, and up. Find the alarm that works best, for your situation.
  
  There are some pain sufferers I know who have built-in security systems, in the form of a large dog. If you have a service animal, chances are, the presence of a large dog is enough to frighten off would-be thieves. What I've always heard is, it's not about total protection--it's about making your home a less likely target. Many thieves merely want an easy place to break into. Statistics show that they commonly look for: (1) Easy access to the property combined with low visibility, (2) A Home that is/appears to be unoccupied, and (3) something worth stealing. Of course, there are a lot of ways to combat these issues. Read more about securing your home now.


• Out of Sight.
  Because our main concern for possible theft are our medications, at home, never leave your prescription bottles in plain view through doors or windows. The break-ins at the senior community I mentioned earlier started with a woman taking pain medication. How was she targeted? Her prescription bottles were visible from outside; they were sitting on her kitchen window sill. Locked or not, it's not safe. Her window was smashed and the bottles were taken. The thief never actually entered her home, and yet, he took her pain medication. Obviously, losing pain medication could prove very problematic, but sadly, a thief isn't the only way they can be taken.
  
  We've already discussed the idea of a safe, and keeping meds out of the view of doors and windows. Realistically, though, where do you keep your day-to-day medication? My personal choice is to keep only a day's worth of medication on me. I have nearly all of my prescription medication in my safe. Then, I keep my non-prescription items as well as about a week's worth of pain medication, in a top-secret place somewhere in my home. Let's just say, it's not in a medicine cabinet or any other place where one might typically store medication.
  
  Why? I am extremely cautious about my medication falling into the wrong hands. Whether it be a friend, family member, plumber, locksmith, tv repairman, whoever... no one knows where my meds are kept, nor would they ever accidentally come across them. As for my single day's supply of meds, they're always right with me. If you're planning to be away for short time, a small pill container can provide access to meds in your nearest pocket. Another convenient way to take a small amount of medication with you? Tiny re-sealable bags, called "Pill Pockets." They're for sale with various names at any drug store and all over the web. If you want/need a slightly larger bag, I have seen bags meant for jewelry at one of those discount chain stores. Additionally, you can use what is referred to as a "snack size" bag, sold in all grocery stores. Half the size of the standard "sandwich" bag, these bags will hold what most patients would need, for an entire day--or longer. Once you have your pill bag, it can be stored anywhere, pocket, wallet, purse. Wherever you choose to put them, make sure your meds are always with you, but not easily spotted.
  
  Treat your medication as valuables. Take it from me, this is the safest way to handle your medication, even at home. I'd guess that most pain patients know the value of their medication, but it's still worth mentioning here. Wherever you think people are likely to look for your medication, don't keep it there! Thieves would obviously check the medicine cabinet as well as shelves in your closet, jewelry boxes, etc. If you can think like the bad guys, you can elude the bad guys.


• You Always Hurt The One You Love...
  I'll go ahead and admit something now, for the benefit of everyone else. In their youth, several of my family members abused street drugs, such as marijuana. And honestly, I have no idea what they're up to these days. I guess my point here is, nobody can know that, really, can they?
  
  When I became a pain patient, I was far too open and honest with nearly all of my family members. Mostly because I was scared, and wanted support. So, all of them, including the sketchier ones, knew I was taking Vicodin. I was shocked when one of these people remarked what a 'fun high' he got from Vicodin. It made me sick inside, but I said nothing. Then, this same person asked if he could have one a few weeks later. I was so shocked, I didn't know what to say. I muttered something about running low and that I couldn't spare any. What do you say to a question like that? I went home and sobbed for a while, then tried to figure out what to do. I was very fragile back then, admittedly.
  
  Then it hit me... I told the most talkative (ahem, gossipy) family member about what happened, knowing my feelings would soon be known to everyone. I stressed how much that question hurt me. Then, I made it clear that I didn't think that taking pain meds like Vicodin was in any way fun. Even more, I didn't want someone to ask me for them, like they were some kind of party favor. It totally discounted what I was going through. Even worse, it made me wonder whether he, or anyone else in my family, thought this whole pain thing I was going through was some kind of joke!
  
  Nowadays, of course, my reaction would be drastically different. I would've probably calmly but rationally explained the plight of the pain patient, 'til he was bored to tears, and went elsewhere looking for something to get high on. I share this story for a simple reason: Friends and family may seem supportive, but the reality is, you can never 100% know anyone's penchant for drug abuse. Some may privately judge you for taking pain medications, while others secretly wish they knew where you keep your 'stash.' It's a sickening thought, and believe me, I never would've felt this way, til I was directly confronted with the issue. Call me jaded or call me enlightened; either is fine with me, so long as my medication is safe.
  
  I believe there are two reasons I was approached directly about my meds and this person didn't just try to sneak some, on the sly: (1) He wouldn't have had access. Even at a friend's or family member's home, I always keep my meds right with me. If they happen to be in a purse, that purse never goes out of my sight, for any reason. Don't feel pressured to give up your purse, even at a fancy shin-dig. It's your safety that's important, here. (2) I have never been the type of person to judge what other people do. I've seen people smoke pot and drink to excess. I've never really cared what people around me do, so long as they are safe about it. I've driven people home a time or two, just to be sure they arrived safely. This family member obviously thought I'd be 'cool' with his request for my pain medication, merely because I'd never expressed disapproval over his past drug abuse. Realize that most people will not be this upfront about their desire to separate you from your medication. Protect those meds like the life-saving miracle that they are!
  
  Use my experience as a warning. Now, you have time to prepare yourself for the possibility of this happening to you: (1) Think of what you would say if someone you care about approached you for a pain pill, even if they came up with an excuse, like a toothache or menstrual cramps. Know that if you share meds with them, you are risking your care and they will likely come back for more. (2) Realize it is far more likely for people to take your meds, behind your back. Take every precaution--it's better to play it safe, than have to try to explain to your doctor what happened. Or, worse yet, be pushed into a situation where you're forced to file a police report about an incident with a family member, in order to ensure your doctor will continue to trust you and prescribe your medication.


• Need-To-Know Basis.
  Since my eyes were opened in this most unfortunate way, I've decided that it is nobody's business what medication I take, or even that I take medication for my pain. Not only do I leave the topic of meds completely out of the conversation with just about everyone outside the pain community; certain people haven't been to my home ever since 'the incident.'
  
  Even those who are invited to my home are not given an all-access pass. My bedroom door is generally closed and there is also a lock preventing anyone from even gaining access to the area where my safe is kept. I take this issue very seriously, because loss of medication is such a serious issue. Your doctor and your pharmacist count on you to keep your medication safe. Any careless behavior could mean you have a harder time getting pain medication in the future. Believe me, it happens; there are many sad stories out there. In fact, a recent articles that say the most common way young people get access to pain medication is through a friend or relative. It makes sense--just be careful!


Strengthening Safety at with Other Medical Professionals

What should you do when asked about your medication use by a medical professional, other than your pain management physician? These days, I think it's more important to protect myself than to provide specifics, whenever possible. Here's why: I had a bad experience with a dentist when I told them exactly what medication I was taking. In order to treat me, they wanted my doctor to fill out a very detailed waiver form. Additionally, my chart had all these bright warning labels on them, causing several uncomfortable conversations. And, let's face it, some biased treatment by people who think everyone taking pain medicine must automatically be an addict. As a result, I am now as tight-lipped as I can be, while still telling the truth.

I provide a list of all non-pain medications, identifying them by name. Then, instead of listing my two different pain medications by name, I simply put "opioid pain medication." I figure that this covers the topic thoroughly enough, for most circumstances. If I was ever asked for the specific names, I would provide them. However, thus far, it hasn't come to that. I believe this does two things for me. First, it prevents me being judged by people who don't understand. More importantly, it keeps a whole bunch of people who have access to my chart from knowing both where I live and what type of pain medication I have in my house. No matter the situation, I have to think about my safety, first and foremost.

Why do dentists and other medical professionals ask for a list of the medications you are taking? The main reasons are to prevent drug interactions as well as to ensure you don't have some underlying health issue that may cause you problems, if they perform a procedure. The vague term "opioid" covers that class of medications very well. A drug interaction that may exist for one opioid, likely exists for all of them. But, as I said, if I was ever asked for the complete list of my medications, I would give them--to ensure my safety in treatment, as well as the safety of my access to life-saving medication.


• Pitter-Patter of Little Feet... or Paws.
  Adults, or even teens in the home, are one thing. But, what about small children or pets? Obviously, the strong opioid pain relievers which are intended for Intractable Pain sufferers can be dangerous, even to a grown man. It makes sense that they can be deadly to young children and pets. Did you know that even over-the-counter pain relievers can kill a cat or small dog? According to the American Veterinary Medical Association, the most common poison small animals are exposed to is medication. Over-the-counter medication is just as dangerous to young children. When it comes to prescription medication, especially pain meds, keeping them out of reach of children and pets is particularly important.
  
  
  In 2010, pain medications were the second most common poison exposure addressed by the National Capital Poison Center. (The most common exposure was cosmetics or personal care items.) Last year, 55% of all the calls received were regarding medications. Pain medications, and prescription medications in general, are far more dangerous.
  
  According to a 2008 study, the average age of kids ingesting meds meant for adults was 2. They were often toddlers, discovering the medication during exploration of their environment. The study brought to light many ways that children gain access to the meds, unintentionally, providing important ways to prevent infants, toddlers or pets from accidentally ingesting dangerous pain medication. It's important to:
  • Understand child-resistant isn't the same as 'child-proof'--a child may still be able to open the caps.
    
  • Realize that a high shelf or cabinet is not a deterrent to young children--they can climb up on just about anything, making locked storage vital.
    
  • Discard unused medicine--if you don't need it, why have it around? (See more information on proper disposal.)
    
  • Take meds with you if you're called away--never leave them within a child's reach, even for a few seconds.
    
  • Keep purses and bags out of reach, including those belonging to other people
    
  • Inform friends, relatives and babysitters about these dangers; it's just as important as taking precautions yourself.
    
  
  All of these tactics are really about common sense, but as every pain patient knows, the occasional pill does spill. As the owner of 2 dogs, when this happens, it really scares me. I feel compelled to do what I can to pick up whatever I've dropped, as quickly as possible. However, we all know that most pills are round. They don't just drop flatly to the ground--they roll. Because of my spinal issues, there are times when I am simply unable to get down on my hands and knees to go searching under furniture for a dropped pill--which always seems to be deliberately hiding from me! So, what can be done to keep pets and young children safe from dropped pills?
  
  First and foremost, try to pick them up yourself, as soon as possible. If you can't, then you should:
  • Ask a loved one or caregiver for help, immediately, if they are available.
    
  • Remove pets or children from the area, until someone else can retrieve the pill.
    
  • Have someone vacuum your home and any vehicles you ride in, thoroughly, at least once per week (moving/vacuuming under all anything that pills could roll under).
  
  Because just one dropped pill can kill a child, some Intractable Pain sufferers prefer not to have young children in their home. It's a difficult choice, but such a sacrifice does ensure children are safer. According to the study mentioned above, nearly all of the accidentally ingested medications were prescribed for an adult in the household. Furthermore, 92% of the meds were ingested by children in the home. Based on these statistics, it may be the safest choice to keep young children out of such an environment. If the child in question happens to be your own child, obviously this is not an option. Vigilence is necessary, to prevent a serious accident.
  
  When it comes to accidental ingestion by pets, the medications that are most appealing to pets are those with a sugar-based coating (such as ibuprofen) or a gelatin capsule or 'gel-cap' (commonly used for antibiotics and non-prescription supplements). Obviously, these smell like food to an animal, and are thus the most dangerous to them. This does not mean other medication is safe, left on the floor, however. Keeping this information in mind will help pet owners keep their home safer for their animals.

Strengthening Safety in the Car

• Lock It, Hide It, Keep It.
  Just like safety in the home, common sense guidelines keep you and your medication safe, in the car. The Los Angeles Police Department released simple guidelines: Lock It, Hide It, Keep It! Always lock your car and ensure the windows are fully closed. Don't leave your medicine or anything of value where people can see it--this includes things you typically keep in your car, such as a GPS which you affix to the window, as well as CDs. Hide these items out of view of would-be thieves--or better yet, when possible, keep them with you. People have broken into cars just to grab a pair of sunglasses!



• Your Littlest Passengers.
  Whether medication is dropped in the home or in the car, it is equally dangerous to children and pets. If you ever have toddlers, dogs or cats in your car, it's important to be sure they're safe. In just seconds, your little passengers the can find whatever is on the floor of the vehicle. Ensure the car is frequently cleaned and vacuumed by someone you trust. And, of course, whenever possible, pick up dropped medication before it becomes a hazard to anyone's safety. Because of frequent temperature changes, it is not a good idea to store extra medication in your glove compartment. I find it helpful to keep a small amount of fast-acting medication in a tiny container, in my purse, as a backup. Now sold at nearly every pharmacy chain and Amazon.com, I keep a couple of pills in a tiny resealable bag. They can be extremely useful--stick a couple of extra meds in your wallet, pocket, you name it.


• Know Your Rights.
  Being pulled over by the authorities is a common fear among even the best drivers; for pain sufferers, this is more of a genuine concern. How do you explain the pain medication you have in your car? Several relevant issues have been addressed above, but obviously, there are greater concerns than just what container to put your medication in. There are much larger legal issues that truly would be best handled by an attorney. So, understanding that I am not an attorney and that the advice in this article is in no way a guarantee, let's address some of these issues.
  
  According to the Flex Your Rights web site,
  and the accompanying DVD 10 Rules for Dealing With Police, there's quite a lot you can do, to protect yourself:
  • Rule #1: Always Be Calm & Cool - A bad attitude guarantees a bad outcome.
    
  • Rule #2: Remain Silent - What you don't say can't hurt you.
    
  • Rule #3: You Have the Right to Refuse Searches - Saying 'No' to searches can't be held against you.
    
  • Rule #4: Don't Get Tricked - Remember, police are allowed to lie to you.
    
  • Rule #5: Determine If You're Free To Go - Police need evidence to detain you.
    
  • Rule #6: Don't Expose Yourself - Doing dumb stuff in public makes you an easy target.
    
  • Rule #7: Don't Run - They'll catch you and make you regret it.
    
  • Rule #8: Never Touch An Officer - Aggressive actions will only earn you a more aggressive response.
    
  • Rule #9: Report Misconduct - Be a good witness.
    
  • Rule #10: You Don't Have To Let Them In - Police need a warrant to enter your car or home.
  
  All of these rules are words to live by. They were developed by a former police officer who really knows his stuff. When the authorities pull you over, get out your license, insurance and registration--be prepared to show them to the officer when asked. Put your pain medication out of sight, such as in the glove compartment or in your purse. Zip your purse closed. Even if you have a shiny cell phone sticking out, they could say it looked like a gun and thus had 'probable cause' to search. Don't give them any reason to want to see what's in there.
  
  
  As the officer approaches your car, roll down your window and keep your hands on the steering wheel, where they can see them. Smile. Politely ask why you were stopped, even if you think it's obvious. Don't say anything else. If they engage you in a guessing game, by asking "Why do you think I pulled you over?" Remain calm, say you don't know. If they ask further, stand strong and nicely repeat, "I don't know."
  
  They can be really forceful. If an officer leans into your car and asks, "You don't have any weapons in there do you? Mind if I take a look?" Questions like this are meant to throw people off-balance. You may be tempted to emphatically say, 'No! Of course I don't have any guns!' The natural inclination, then, is to prove it. Police know this; don't fall into their trap! Instead, when posed with such a question, very calmly say, "I do not consent to a search." No explanations, keep it simple. Remember they are trained to shake your confidence.
  
  Trying once more to get under your skin, they may say things like "You know, innocent people consent to searches..." Hold your ground. Police also often ask compound questions to obfuscate meaning--one with a 'yes' and one with a 'no' answer. Don't get tricked! Just state your position calmly, and do not get entrapped. Smile and repeat yourself: "I do not consent to a search." If you give in, your rights immediately go out the window. Anything they find can, and will, be used against you.
  
  As an Intractable Pain sufferer, who among us can spend even one night in jail, while a mess like this gets sorted out? Don't put yourself in a situation where you need to prove your innocence. Remember, if they don't step into your door, they cannot find anything. Knowing your rights can save you lots of undue stress and even pain. Think you'll forget this information, in the moment? Write these tips on an index card and put it in your glove box. Refresh yourself, if necessary. The officers always seem to take forever to approach the vehicle--it'll give you something to do.
  
  Additionally, memorize your Miranda rights--they read them to you for a reason! "You have the right to remain silent. Anything you say can and will be used against you in a court of law. You have the right to speak to an attorney. If you cannot afford an attorney, one will be appointed for you. Do you understand these rights as they have been read to you?" Even though these are usually only read to you if you are arrested, these rights sum up all the areas of a traffic stop that are important, as discussed above. Keeping these in your car's glove box could also prove beneficial.
  
  Other Useful Phrases: "Am I under arrest, or am I free to go?" "Am I being charged, and if so, with what?" "I retain my fourth amendment rights against unreasonable search and seizure." These can all be useful phrases, but remember, Rule #2, above all else. If you continue to talk, they will continue questioning you. Whether in your car, your home or at the police station, remain silent as much as possible. Even if you're just expressing your rights, you can unnecessarily lengthen your contact with the authorities. And, the police don't especially like having 'rights' thrown in their face. Don't rattle them all of, just to show what you know. If they continue to press you for answers, the most important phrase is: "I do not wish to be questioned without a lawyer present. I want an attorney." Remember: Say only as much as is necessary, to get the heck out of there and go home!


• Be Prepared for the Worst.
  Even more scary than being pulled over, how should we, as pain patients, handle the possibility of being drug tested? Whether at the scene of an accident or because an officer believes you're driving under the influence, there are many important tactics you can use to protect yourself. There's an excellent card with your rights printed on it--downloadable from the American Civil Liberties Union. It's a very detailed paper with small print, covering every possible scenario. Read it thoroughly, and better yet, keep a copy in your car. (An easier to read copy is available at the ACLU web site.)
  
  A lot of what is on the ACLU card is similar to the 10 rules listed above--just in greater detail. Some additional things to keep in mind:
  • If you're pulled over, you can refuse to consent to a search. However, if police believe your car contains evidence of a crime, it can be searched without your consent.
    
  • Both drivers and passengers have the right to remain silent. Many times, pain patients are passengers. If you are a passenger, you can ask if you are free to leave. If the officer says yes, sit silently or calmly leave. Even if the officer says no, you always have the right to remain silent.
    
  • If you are arrested, do not resist, even if you believe the arrest is unfair.
    
  • Say you wish to remain silent and ask for a lawyer immediately. If you can’t pay for a lawyer, you have the right to a free one. Don’t say anything, sign anything or make any decisions without a lawyer's advice.
    
  • You have the right to make a local phone call. The police cannot listen if you call a lawyer.
    
  • Prepare yourself and your family in case you are ever arrested. Memorize the phone numbers of your family and your lawyer (Or keep a list with your license.) Make emergency plans regarding your medication; discuss this with a lawyer to determine the best way to ensure your life-sustaining treatment. Also discuss the fact that you are disabled with an attorney and find out the best way to proceed.
    
  • If you feel your rights have been violated, know that police misconduct cannot be challenged on the street. Don’t resist officers or threaten to file a complaint.
    
  • Write down everything you remember, including officers’ badge number and patrol car numbers, and any other details. Get contact information for witnesses. If you are injured, take photographs of your injuries, after seeking medical attention.
    
  • File a written complaint with the agency’s internal affairs division or civilian complaint board. In most cases, you can file a complaint anonymously if you wish.
    Call your local ACLU. And, of course, any questions you have should be addressed with a lawyer that is well-versed with the laws in your state. Arm yourself with quality information, so you can be as safe as possible, behind the wheel.

Strengthening Safety When You Travel
Pain sufferers realize that travel is difficult on the body, but it doesn't have to be as stressful. When it comes to travel, ensure you have everything you need. Make sure the person you are traveling with understands your limitations, and be sure to speak up, if you need to change plans for any reason. Being open and honest will go a long way towards making your trip more enjoyable.

• Planning Ahead.
  When it comes to packing, every pain sufferer has concerns. How exactly do you ensure safe travel--for you and your pain medication--with the ever-changing restrictions? Your first stop should be the Transportation Security Administration (TSA) web site. Be sure to check the current rules for disabled travelers. Also, visit check the TSA home page for any possible changes to these policies; up-to-the-minute changes can be found there. Ensure you are packed and ready to leave with plenty of time to spare. At least four hours before your scheduled departure, check the TSA site. Nobody wants to leave home without knowing there are unanticipated delays at their departure terminal! This web site can provide a whole lot of peace of mind.
  
  Beyond the TSA, there are many technological advances that make travel easier. If your departure gate has changed or the departure is delayed for any reason, most companies now have automated phone systems to provide this information. You can simply call the number listed on your ticket. When making your reservations, online or by phone, check to see if you can receive automatic updates. If you provide a mobile telephone number, you can receive text messages or even phone calls with information regarding your departure. Then, as your departure nears, you will get the information you need.


• Luggage and Packing.
  As a pain patient, you may feel as though it is easier to put your medications into your checked luggage. Though this seem easier, it opens you up to serious risks, to both your health and the safety of your pain medication.
  
  Difficult or not, carry all of your medications with you, at all times. I find it easiest to keep my medications, as well as my money and identification, in a purse. (Guys, a small zippered bag works just as well.) When I travel, especially if it's for a week or more, I take my original pharmacy vials with me. I also have a weekly pill sorter, to divide my meds into, for easy access. So long as I've got the pharmacy paperwork with me, there can be no doubt that it's mine.



• Paperwork.
  If you hadn't already guessed, I also bring copies of my documentation from the doctor's office, whenever I travel. You should too! If your doctor doesn't have an annual document with proof of your diagnosis and need for pain medication, have him write a letter, similar to the agreement discussed above. Keep a copy of your diagnostic/prescription paperwork right next to your medication--it helps you answer any questions later on, if need be. Additionally, make an extra copy of this paperwork, and place it in your checked bag, in case you misplace the copies in your carry-on.
  
  Because I'm cautious by nature, I also make a copy of my license and/or passport, and place them with the medical papers, in my checked bag. You can never be too careful! Proof of who you are is important, no matter where you go. Plus, it provides people with your name and address, just in case your bag is lost!
  
  Another tip: Because I find it easier, I usually place any non-essentials, including comfort items, snacks or time-passing favorites in a separate bag--usually in a wheeled, airline approved carry-on bag. Whenever possible, I try to stow my 'essentials' purse inside the larger 'non-essentials' bag, when it is not needed (such as on my way to the airport). However, for the duration of the flight, I keep that purse with me, and stow the carry-on at my feet, or above me. I never have my medication, money or identification out of my sight!
  
  A final note on departure times: Leave earlier than normal for your destination. I generally give myself approximately two hours for a U.S. destination, to ensure I won't miss my flight or cruise. Why? You want to ensure you have additional time for check-in at the airport, cruise ship, etc. Wherever you are going, assume the check-in process will be a bit longer than normal, because you will be up-front about your disability, your medication and your need for any special assistance/processes at check-in. My policy has always been: Assume the worst, hope for the best.


• Checking In. Whether for a flight or a cruise, it's important to let people know, as soon as possible, upon check-in, that you are disabled. Even if you do not believe you need any special assistance, letting people know you are disabled at the outset will prevent any issues during the screening process. How do you do this? Smile, ask how their day is going. Then, calmly and politely explain you are disabled and what extra precautions need to be taken, if any. Want to feel more official, as you discuss the situation with TSA? Why not invest in an inexpensive medical alert bracelet or necklace, to wear when traveling?
  
  For patients with a medication pump/stimulator or any other fragile medical equipment, it is always best to tell them, at the outset, where this device is located. Taking the guesswork out of an already tense situation makes things easier for you, and the screener. This is also the time to explain that you require a special manual 'pat down' screening. Explain that you need a private screening; no wand, no x-ray machine. Note: A private screening is the right of every traveler, disabled or not. For this reason, be sure to tell them you require this, so that your very delicate equipment is not damaged. Most TSA workers know the drill; they deal with thousands of people every day, some of them are bound to be pain patients.
  
  Tip: If at all possible, bring a fact sheet regarding your device with you. This helps explain what it is, what it's for, etc. If you do not still have the paperwork that came with the device, there is sure to be something similar online. The simpler the better. Many such devices have a long, multi-page manual. They also have a slick, one-page marketing sheet, describing the device in simple terms. Always go for the simple, one-page explanation.
  
  If at any time your special request is not honored (or someone appears new or ill-informed), don't back down. You need this special request, or you wouldn't be asking for it. Smile, then confidently explain your needs and why you need them.
  I have heard from several frequent travelers that TSA Agents do not always provide a private screening in a timely manner. Screeners have explained that due to workload and number of screeners available, a private screen would take so long, the person would likely miss their flight. In these cases, pain patients have consented to a pat down screening in the open. This can be quite unpleasant, it not embarrassing.
  
  Keeping this in mind, if you truly want a private screen, plan ahead, giving TSA the extra time necessary to do so. If you travel out of a specific airport the majority of the time, why not call TSA and enquire about the time required to provide a private screening, to you, a disabled traveler? It never hurts to ask.
  
  If your airport experience is less-than-ideal, don't be afraid to ask for a supervisor's assistance, as calmly and politely as possible. Anyone can have a bad day; we've all been there. Remember, being a TSA agent is a difficult job; they're keeping us all safe as we get where we need to go. You know the saying about the flies and the honey. Be nice and things generally go much better than if you explode. (Believe me, I know from experience--it's not pretty!)
  
  One final note: If you ever feel you've been treated unfairly by TSA, it is your right to report the issue. Visit TSA's Traveler Redress page for more information. Additionally, all travelers should check out TSA's Civil Rights for Travelers. Travel can be a nightmare, but the better prepared you are, the easier it's bound to be! And, it'll be safer, as well.

Download a simplified guide, containing all the tips in this article now.

Written: December 30, 2010. Updated: February 10, 2011

Anti-Opioid Sentiment Harms Intractable Pain Patients

by Heather Grace

Why must I find yet another anti-opioid story that serves to increase an ever-tightening grip on options for care? It's a question I seem to be faced with a lot more, lately. That doesn't change the reality of a life in pain. Intractable Pain patients are suffering needlessly, while the world keeps on doubting us all.

People who are in severe pain count on their pain medications. Prescribed meds like Oxycontin keep them alive. They truly have no other choice; take the medication or suffer a miserable existence leading to an even more excrutiating death. Nobody wants to tell that story... it's not seductive--it doesn't shock people into screaming at the television.

The only issue that's focused on? The evils of opioids. Somehow, the fact that this medication is being abused gets swept under the rug. When you want to scare someone, you tell them about all the poor, misguided teens who are falling victim prescription medication like Oxycontin.

Nevermind the fact that the medication was gotten from a drug dealer, illegally. Sensationalized stories forget to mention that many young people with addictive tendencies will do whatever drugs they can get their hands on. Oxycontin is just one of many substances that are being abused.

Still, these stories lead to a frenzy on the part of well-meaning but ill-informed citizens. They scream: Why doesn't someone DO SOMETHING to save the children? The reality is, these medications are already very tightly controlled; moreso than anyone would ever imagine.

Let's look at just one example: the Drug Enforcement Agency (DEA). The DEA tracks doctors and also has a record of each patient who is prescribed opioid pain medication. They can, and often do, go after even the best pain doctors in the country. The mere threat of the DEA, as well as medical boards throughout the U.S., have done a lot of damage. Nearly all pain management physicians today are forced to wonder if it's worth the risk to treat their very ill patients. This becomes a serious threat to patient care.

It would be great if people who trashed opioid pain medication knew the whole story, so I would like to help tell it. Yes, that's right! I am an Intractable Pain patient turned Advocate!

There has recently been a reformulation to Oxycontin. (April 2010) It is said to be less effective when drug abusers crush the pills and then inject or snort it the medication. This drug did not go through the formal FDA process in order to become approved for use. Instead, all the hyped surrounding Oxycontin helped to push it to the market.

The old version of Oxycontin is now off the market. The response has been anything but positive. People who are just trying to get high will always find a way. The saddest part? Even the FDA says that addicts can merely use larger quantities to get the job done!

The real problem is that the new formulation of Oxycontin is far less effective in treating Intractable Pain patients. The pill is clearly less effective at providing pain relief. I have seen the effects with my own eyes, in someone I love dearly. All of this was done in the name of safe medication. I can say, with confidence, that well-meaning people are using the word "safe" without realizing the ramifications to our very health and yes, our safety.

Many more patient deaths occur due to under-treated or even completely untreated pain than due to misuse/overdose. Pain causes reduced mobility and a consequent loss of strength, disturbed sleep, immune impairment and increased susceptibility to disease*. Any of these conditions can lead to more serious medical problem.

Worse yet, under-treated, severe, chronic pain leads to heart attack or stroke, a condition called Cardiac Adrenal Pain Syndrome. Then there are those who cannot get treatment and commit suicide.

I know several other pain patients who are getting some degree of relief after years being treated by bad doctors. The number of so-called "pain management physicians" who completely shun opioid medications is astounding. So many doctors are actually afraid to prescribe them. Why? The big, bad DEA lurks in the shadows.

It is astounding how long it takes to find a doctor who cares enough to treat serious pain! Patients try and fail to find help year after year. It's no wonder so many give up and end it all.

Even the ones who eventually get help admit they seriously considered suicide. When the pain gets bad and no one listens, it becomes hard not to think about it. The lucky few, like me, eventually stumble across a caring physician who is able to better manage their pain. However, it is still a life of constant pain... Pain that needs to be treated!

When you talk to most people, they readily agree that their greatest concern at the end of their life is: a peaceful death.... one without suffering. However, people with conditions like Intractable Pain, Peripheral Neuropathy, Reflex Sympathetic Dystrophy, Complex Regional Pain Syndrome (Types I and II) or Fibromyalgia live a lifetime in pain. Don't people with these conditions deserve some degree of relief? Must they suffer in silence and die a miserable death, feeling, in the end, that no one cared?

Well-meaning people may want to sanitize the world for our protection. However, there is one thing these people seem to forget. As a good friend said to me: Pain medication is for pain patients, just as insulin is for diabetics.

Yes, addicts will abuse drugs. Whatever they can get their hands on. But does that mean we should further restrict access to something that is already near impossible to get? It took me seven years to get a real pain management physician. Yes, SEVEN YEARS! That length of time in severe pain should be a crime!

Before then, I was actively trying to find a way to kill myself. It wasn't a decision I came to lightly. I had tried everything else I could think of first. Physical therapy, acupuncture, occupational therapy, over-the-counter medication, muscle relaxers, non-opioid pain relievers, stretching machines, TENS units, sound waves, spinal decompression, ultrasound... you get the picture.

After being through all of this, with no relief, I wanted to just lay down and die. I tried to think of a way to commit suicide where I could do it quickly, without in any way impacting anyone else. The biggest reason I am still here is because I couldn't find a way to end it all that was definitely going to work out this way!

A year later, I found a great doctor. I am thankful I managed to hang on by a thread, but many do not! Many commit suicide, giving up after the pain gets too great to bear. Then there are those who are crying and screaming their way through each long, difficult day. Still actively looking for their miracle. That's what this doctor was for me... a miracle. The one and only answer to the problem no one else had ever cared to solve.

Many Intractable Pain patients still do not have a physician who will treat them, where they live. Many have to drive hours or even fly out of state to get care. It is a far more serious situation than any non-pain patient could possibly contemplate!

In fact, it trumps any need for restricted access to opioid pain medication. If you build a better mouse trap, guess what? The rats get bigger, meaner and angrier. And, in the end, yes, they still find a way to get their cheese! The addicts or dealers don't go through legal channels like pain patients do, and they never will!

However, this desire to keep pain medications out of the hands of drug-seekers has gotten completely ridiculously over-wrought with problems. The DEA and state medical boards should not jeopardize those of us who have 20 or more years of unrelenting pain left to live through! Sadly, that doesn't mean anything to them. They still chase after the supposed bad guys.

Meanwhile, these saintly physicians are just trying their damnedest to help people--while not going insane from the pressure. Like it or not, any doctor who will treat "us" lives with the constant fear. They work under an undeserved cloud of suspicion and misunderstanding. It's no wonder so many are closing their doors!

A change to the formula of Oxycontin is just one case of well-meaning people making poor decisions, mostly because they don't have all the information. Yes, before I was a pain patient, my gut reaction would be very similar to most people. I would probably still be thinking it was important to keep all these seriously heavy duty drugs out of the hands of the bad guys. I had no clue what was happening to pain patients all over the country.

Now that I do, I can tell you how BAD it truly is. It's downright ugly! It is way past keeping these meds from addicts. The restrictions in place actually keep necessary medication out of the hands of the pain patients they were intended for.

Please, I urge all of the well-meaning people out there to think before they act... because all these changes are severely impacting our access to medication. Even worse, the number of doctors who will truly treat pain lessens each year! This creates a mountain of stress we each live all with, day by day, always fearing the worst! Because, the worst is already happening! Right here, right now.

If you want more information, please look at the American Pain Foundation's site or see patient stories on their special site: The 10,000 Voices Campaign. There are videos all over You Tube that are very similar, from pain patients who passionately tell their stories.

Drug abuse is a serious problem, to be sure. However, consider what untreated pain is doing to people like me, all the time. Intractable Pain ruins innocent lives day after day... people who just want treatment for their misery and suffering. This is a far more serious story; too bad no one seems to really hear it!

The reality of the situation is, only the BAD GUYS are winning this fight. Pain patients lose. Caring doctors lose. Anyone who is in pain but isn't sure what's wrong with them loses. They get misdiagnosed or just plain turned away. Their fate? To be deemed a freak, liar, miscreant, faker. Then, if they are persistent and just lucky enough, maybe one of the doctors will take a chance, and really look at what is going on.

If not, they are destined to dance on the edge between life and death, wondering whether it's time to just give up and let death win. Tell me... who among you really wants to live like that?

Not me! But guess what? I have no choice. I'm an Intractable Pain patient! I'm labeled, doubted, disbelieved, you name it. I just continue on, living as only a pain patient turned advocate does:

Trying to cope with the pain and do something productive.

Trying to convince just one more person at a time to see what's really happening to us.

Just one more today... maybe you?

Tips & Secrets: How to Find a Good Pain Management Doctor

by Heather Grace

Living each day in pain is hard enough. Being diagnosed an Intractable Pain illness such as Central Pain Syndrome can be really scary. Obviously, you want to find a doctor quickly, and get the pain under control. That would be everyone's next logical step. However, as any persistent pain sufferer knows, it's really not that simple.

In this era of the Drug Enforcement Agency (DEA) and various state medical boards becoming watchdogs over prescription drugs, it can be hard--if not impossible--to get treatment for even those most serious diagnosis. If you've been diagnosed with any condition that causes severe, chronic pain, you've probably suffered far more than anyone should, in the system, just trying to get adequate pain management.

Conditions such as Central Pain Syndrome, Adhesive Arachnoiditis, Cauda Equina, Trigeminal Neuralgia, Interstitial Cystitis, Peripheral Neuropathy, etc., often go undiagnosed for long periods of time. They are ignored by family practitioners, chiropractors and even those claiming to be "pain management" physicians. I'm not saying they don't care about patient suffering. Most do care. However, the ugly truth is, far too many are unable to adequately care for such people. Worst still are the doctors who are--for various reasons--unwilling to treat these illnesses.



If you're suffering, afraid and know your pain is becoming harder and harder to cope with, what is the answer? Where can you find the best pain management physician in your area? Obviously, the answer isn't simple. With perseverance, however, you can find true pain management... just like I have. I am not going to pretend my story isn't a nightmare of both medical neglect and misdiagnoses. However, there is good news! Through my more than 10 years dealing with pain, I have learned a great deal about what works, and what doesn't.

How to Find a Good Pain Doctor:

Documentation. -- If You're In Pain, Be Ready To Prove It!

Yes, it's a bit twisted. If you're dealing with serious pain, it doesn't seem fair that you should have to provide 'the facts' in order to get good treatment. You must get over this and just realize it's part of the process. Think of it from Dr. X's point-of-view. Most doctors, even the good ones who want to help you, are afraid they could be criminally prosecuted. Providing a prospective physician with documentation that backs up your pain will protect you. And, in doing so, it provides your potential new doctor with evidence necessary to feel safer taking you on, as a patient. This helps you to get the pain relief you are seeking.

What will you need? First and foremost, keep everything that helps document your condition, in black and white! If you've had chronic pain for years, somewhere along the way, you must've received sort of written proof of your suffering. Keep a file of such information handy.

Your files should include: all x-rays, MRIs, CAT scans, the accompanying reports, each physician's diagnostic information and any other hard facts about your condition. Be sure you also have a list of contact information for every physician you have ever seen, even those you only saw for tests, like an MRI. There are other hard facts you can compile, besides what you get from a doctor.

For instance, you could keep a pain journal. Document each day's pain: a list of physical of your symptoms, describing how your pain feels and how long it lasts, including a rating from 0 to 10. Another good idea? Include your blood pressure and pulse rates, along with your pain rating. People in pain naturally have elavated blood pressure and pulse rates; generally far above the norm.



Keep any other personal records you can. Take pictures of your scars, or pictures that show areas of your body that are visibly swollen/inflammed. Even if you don't think your pain areas are swollen, try taking a photo and seeing for yourself if there's any sign of swelling. My doctor took photos of my head, neck and upper back and the swelling was very apparent, even though I didn't realize it, before I saw the pictures!

HIPAA and Your Medical Records. -- Do I Need All My Records?

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) gives patients the right to access their own medical records. Post-HIPAA, most medical service providers require patient to sign a HIPAA authorization, formally requesting a copy of the medical record. Be aware that HIPAA prohibits charging the patient for the costs of locating and retrieving the medical record. While a "retrieval fee" cannot be charged, each establishment may elect to charge/not to charge patients for records, at their discretion. Laws may differ from state to state, so it's best to review your state's laws regarding fees.

Things get really complicated when you try to get older records. Federal programs, such as Medicare and Medicaid, require records be kept at least 5 years from the date of the last patient contact. HMOs or other healthcare networks may require providers to maintain records for a certain period of time.

What does all of this mean? Time is of the essence! It's important to try and retrieve your records as soon as possible, to ensure your information does not get destroyed! Review your state regulatory board’s requirements and/or your insurance provider's rules regarding record retention.

Also, when a physician or other provider closes/relocates, rules may be different. Look into any special state provisions governing handling of the medical records. In these situations, it's always best to get your records, as soon as you are aware of the change. It's your duty to be your own advocate concerning your medical records. After all, no one else needs them as much as you do! Who should you ask for your records? Everyone!

Records: Hospitals, Physicians and More. -- Get Everything, Quick!

If you've ever been in the emergency room and/or been hospitalized for any length of time due to your condition, you must follow up with these providers and get all documentation. Sadly, it may be the only way to prove you've been given morphine or similar stronger medications to treat your pain. If any of these visits included x-rays, MRIs or CAT scans, specifically ask for a copy of these films. (This may prove costly, if printed on actual film. If cost is an issue, when possible, get them on CD. This is generally cheaper and could even be free.)



Be prepared to get all your files from every doctor you have seen, throughout your pain treatment. Always ask for x-rays, MRIs and CAT scans, on disc or printed on film. Realistically, it is best to have records dating back as far as you can, regarding any surgeries, illnesses, etc. That includes traditional doctors, previous pain doctors, holistic healers, support groups, everything!

A Complete Treatment History. -- What Do I Need?

Having a complete treatment history is very helpful. You will find that pain doctors want a complete history of every remedy you have tried. This includes every medication you've taken for pain, every physical therapy modality, acupuncture, chiropractic care, etc. For example, if a prior doctor treated you with XYZ medication, then you will have proof of this.

Believe it or not, this documentation can save you a lot of hassle, when dealing with insurers. Many insurers require patients to have what is called step therapy. Believing that it saves money, certain drugs must be tried first, before you can get coverage for a specific medicine that may be more costly. Records of the medicines you've taken can prevent unnecessary squabbles, getting the insurance to cover a new medication; especially when you can prove you've already tried the others! Even more importantly, this gives a doctor a picture of the hell you've already been through.

The bottomline: If you have the documentation, then physicians will see how hard you've tried to get adequate pain relief. Even more than that, they will realize you are serious about pain management, and are not just a drug seeker, who hasn't tried any other treatments. It's an unfortunate label, but because of the fears doctors have, many wonder if the new patient they are seeing is just there for meds. Records validate your situation and help avoid misunderstanding about your motives. Tip: When trying to get a complete list of medications you've used, it may prove useful to request a report from your pharmacy regarding your past prescriptions.

How Do I Find The Best Fit For My Needs? -- The Hard Truth...

If you are a patient with severe, chronic pain, chances are, you will need some sort of pain medication, i.e. opioids, as part of your treatment. This is just a fact of life for those of us with Intractable Pain, RSD, CRPS, Fibromyalgia, etc. It's easy to feel that this makes you bad or wrong or that you are somehow not as good a person as those who "tough it out" without meds. But, if you are suffering, remember this: Pain medicine was made for pain patients!

Even though we know this, it's still NEARLY IMPOSSIBLE to find the right physician. Why? It's all about fear. Sadly, you can no longer just call up a physician's office, even those who specialize in pain, and get a straight answer regarding treatment protocol. Everyone is hyper-focused on what may happen if it's the DEA or the state medical board calling, not just Joe Pain Patient.

So, here's the MOST IMPORTANT TIP I CAN GIVE YOU in this entire article: DO NOT CALL UP ANY DOCTOR'S OFFICE AND ASK IF THEY PRESCRIBE PAIN MEDICATION.

I know that sounds completely ridiculous, but think about it... Most if not all physicians are now afraid they might lose their licenses, merely because they are prescribing pain medication to those who truly need it. If you were in that doctor's shoes, would you allow anyone in your office to admit you prescribe opioids to any random stranger, over the phone? Not likely.

Even worse, anyone who asks such a question could easily be flagged as a drug-seeker, just for asking this question. The DEA has created a very real fear among even the best physicians out there. I have seen it with my own eyes! These are not easy times for the pain patient. So what else can be done? Think logically and use your best research skills... this may be a very tough process!

Your Prospective Physician's Views on Opioid Use. -- Investigate!

Either you, or a friend who's good at using the Internet (and possibly your local university library's resources), will have to do some major research on pain management physicians in the area. This goes beyond using Google or Bing to find doctors in your area who call themselves a "pain management physician" -- that's just the first step. Once you have a list of at least a dozen doctors, go on to the real work.

(Note: For the purposes of the article, I am referring to the doctor as a male, but we all know female doctors exist and treat pain as well. I just don't want to do that he/she and him/her thing throughout the article...ok?)

You must find everything you can regarding this doctor:

1. What do other patients say about him? Look for reviews throughout the internet, at sites like Yelp.com, and any others you can find, that don't charge a fee for the information. If a lot of people say he helped them, chances are, at least some of his patients are being prescribed pain medication. Some of them may say this, though you can never be sure, anymore.

Look for hints that people are satisfied with his care and think he does a good job at providing some degree of pain relief. If a good percentage of the reviews are positive, this is a very good start! If the positive response is overwhelming, you may feel confident enough to make an appointment with this doctor. However, there are several other ways to check into the doctor more thoroughly...

2. What doctor have you heard people mention at other doctor's offices, hospitals, etc? Do people think the doctors on your list are good or bad? Can they recommend any other doctors, to add to your list?

Speak to other patients who are like you--they can provide a wealth of information about the good doctors, and the not-so-good ones! Even more than that, ask some of the nurses and front office staff what they think about the doctors that their office refers patients to, for pain treatment.

Or, ask your family doctor, when he refers you, for any information he has about the doctor he recommends. Chances are, someone will be able to provide you a good referral. If that doesn't work, there are advocacy groups out there. Look for one in your area, dedicated to pain patients. Or, visit the American Pain Foundation at www.painfoundation.org.

3. What articles/groups/links does the doctor mention, on his web site? Do these provide any information about the types of doctor he is? If he lists/links to articles about prescription drug abuse or how to detox patients, obviously, this is probably a bad sign. Chances are, he's either against opioid use, or he might even be afraid to prescribe them to his patients.

When looking for the best pain doctor, you really want one who is willing to use all the tools in his toolbox. If he's unwilling to use opioid pain medications, then his bias may get in the way of well-rounded treatment. As any patient knows, trying anything and everything, until you get the right treatment plan, is the mark of a good doctor. Good pain doctors are willing and able to prescribe whatever works.

If the doctor's web site is openly in favor of pain medication (among other treatments), that's great! He's probably a good option. However, if it appears there's any degree of anti-opioid sentiment on his web site, it's important to look into the doctor further...

4. What does his C.V. (curriculum vitae), a.k.a. his resume, say about him? More specifically, what did he focus on in his research? What papers has he written/co-written? What boards does he belong to? What groups is he a member of?

This can be much more tricky. Here's a tip... if nothing on his C.V. mentions the word "opioid" or any known medications that pain patients use (generic names such as: codeine, hydrocodone, morphine, hydromorphone, fentanyl, etc.), then he probably isn't too keen on opioid pain medication.

Sadly, many pain doctors are very procedure focused. They may try various injections in their offices, including nerve blocks, epidurals, etc. There are lots of non-opioid treatments available, and yes, these treatments have helped some, patients. However, from my experience, these treatments simply do not manage nearly enough of the people who are experiencing severe, chronic pain.

A doctor with this sort of C.V. and no further "pro" pain medication evidence might be someone you consider a "backup" doctor. In other words, someone to visit only after others have not worked out. Remember, you want a doctor who treats his patients with all available methods of pain relief. A doctor who leaves opioids out of the equation has clearly taken a stand. And, it is most likely a stand against opioid use.

Look at that C.V. in even greater detail. Does the research/writings mention use of pain medication to treat cancer pain? Or end of life care? What about post-operative pain? Sounds like a good sign, right? Maybe. But... maybe not.

The sad fact is, some doctors do prescribe opioids to patients with cancer or those who are near death. Some will even prescribe these medications to patients after major surgery. However, this does not mean they will automatically prescribe to patients with chronic, severe pain. So, just because his C.V. mentions opioids, this might not mean he will treat someone with Intractable Pain, etc. You must take another step, in this case...

Look even closer at that C.V. If the research/writings only mention chronic pain in relation to non-opioid therapy, then chances are, he's wary of utilizing opioids in patients with chronic pain. What non-opioid therapies does that include? There are many. Let's go over some of the common therapies, as well as their common side effects.

Non-Opioid Treatments for Pain & Their Risks

NSAIDs, Cox-2 Inhibitors or Acetaminophen also know as Tylenol, a.k.a Paracetamol/Propacetamol--all of these can cause severe stomach problems or bleeding. Transcutaneous electrical nerve stimulation (TENS), which many say have no side effects--in reality TENS can cause skin irritation/burns, headache or numbness and can kill anyone with a pacemaker. Nerve blocks with a "localized" anesthetic/corticosteroid, which can cause permanent muscle loss, weight gain and "moon-faced" appearance. Epidural steroid injections (spinal tap), which can puncture the spinal cord or cause nerve damage. Prialt (Ziconotide) via pump-based injection, known to cause cognitive impairment, unresponsiveness and even psychosis.

These side effects might come as quite a shock. People tend to think that anything they can get without a prescription comes with little to no risk. Many also believe that non-opioid prescription medication is somehow better for you. Aren't these kinds of treatments "safer" than opioids? Not necessarily. Obviously, you must weigh the risks and benefits of all treatments when deciding what is right for you. Even vitamins and supplements have side effects. This is why all treatments for pain, including opioid pain medication, are overseen by your physician.

So, if the doctor's research/writings include any of these treatments--but none regarding pain medication--this may mean he is against the use of opioids. It's important to weigh all the information you've uncovered, before deciding on the right choice for you.

5. If all of the research thus far has not provided enough information to make an good decision regarding a doctor's stance on pain care, you may want to get access to one (or more) of the papers/research projects, mentioned on the C.V. Any university library should have access to the databases with this detailed information. Be aware that some may charge a fee for this service.

If by this phase you haven't found any definitive answers, it might be best to go on to the next doctor on your list. Once you have selected the best doctor for your needs, you want to be prepared for interaction with the doctor. Trust is key. Thoughts of the DEA loom in most doctor's minds. So, what will help increase your chances of being treated like a true pain patient, and not a potential drug-seeker?

The Actual Office Visit: A Two-Way Interview. -- Be Prepared!

When you visit a potential new pain doctor, you want to be organized, poised and as ready to talk as you are to listen. Think of this as an interview for both of you. He must earn your trust, but you must also earn his. Here are some important ways to make things go more smoothly.

First, bring your best advocate with you, whether it is a loved one, or close friend. Be sure this person is willing to talk honestly and openly about how you have suffered--how pain has impacted you. This will help reinforce the seriousness of your situation. It demonstrates to the doctor that someone other that you, the patient, sees that you are in need of pain management. It may sound like an unnecessary inconvenience, but it truly helps the doctor feel more at ease about the reality of your condition. The more you can demonstrate your level of pain, as well as your desire to get back to a normal life, the better!

Secondly, as hard as it is, remember that this visit is not just about ensuring the doctor can care for your medical needs. It's just as important to reassure the doctor regarding your intentions. You want the physician to see the extent of your illness, but also see you as a trustworthy person who just wants his help regarding pain relief.

In addition to bringing someone with you, here are some important ways to show the doctor the urgency of your situation. Have the following documents with you:

1. A list of all medications you are taking/have most recently taken to manage your pain.

2. A list with all the prescription medications you have tried for pain relief. This should include pain medication, muscle relaxants, sleep medication, anti-inflammatories, etc.

3. A list of all pain-related treatments you have tried. What holistic therapies, acupuncture, chiropractic care, physical therapy, over-the-counter medication, etc., have you tried?

4. Complete contact information for your most recent doctor (be ready to tell him why it didn't work out, as well).

* Note that you can put all of items 1-4 on the same sheet of paper, if they will fit.

5. Recent x-ray/MRI/CAT scan films, especially from the last five years.

6. A list of questions. You can show the list to the doctor, if necessary, to create an open dialogue--and TO ensure all your questions get answered! Additionally, if you have heard of any medications or treatments that you think might be beneficial to you, bring those along as well!

7. Make copies of key documents you have, supporting your diagnosis and the reports/film that supports this diagnosis. This should be just a few pages, that you will give to your physician, to keep.

8. It's not necessary to inundate the doctor with paperwork, but also have other important information from your files (as discussed above) in hand, at the initial visit. This doesn't mean your entire medical history, but key information that supports why you came to be in his office. Example: If you started with one bad disc in your low back, and now you have five, causing pain/numbness/difficulty walking, provide proof of all this. Bring physician reports which detail your diagnoses, as well as an overview of your treatment, what was prescribed, etc.

It's not essential to bring any more than 25 pages. However, assure the doctor that you will provide copies of other pertinent data, on the next visit. It may help to ask him specifically what he would like to see, at a followup appointment.

The more prepared you are for this visit, the better! Ensure that the visit includes a discussion of what does and does not work for you, from the lists you have provided. The goal is to leave the office with an idea of what the treatment plan will be, and hopefully with an initial prescription in hand--a starting point on your road to pain management.

Keep in mind that even seeing the best pain doctor will not be a quick fix. Prepare for it to take a minimum of several months before you get the right treatment, to provide pain management and some degree of relief. This will likely include prescription medication, over-the-counter items such as amino acids, and even increased use of vitamins and minerals, including vitamin D3, calcium, magnesium, etc.

Attention Readers: What do you think of the suggestions included here? Have anything to add? Any DO or DON'T to share? Please leave your comments below. Good luck and here's to better pain management for all of us!