I’m mad!  I’m just not sure who to be mad at!  Several of my patients with chronic pain have complained that no one wants to fill their prescriptions for scheduled medications.  Scheduled medications (mostly narcotics) are more tightly controlled by the feds than non-scheduled medications.

Over the years, I accumulated about a dozen patients with chronic pain.  They all had good reasons for their pain and the majority were on low doses of their medications.  A dozen patients is a small number and I kept it small by aggressively treating pain syndromes with physical therapy, injection therapy, and specialty care using surgery when appropriate.

Towards the end of my career, I was telling patients who needed narcotics that the government believed that anyone prescribing narcotics was a drug pusher and anyone taking a narcotic was a criminal.  Yes, my profession went from openly stating that pain was a vital sign that needed to be aggressively treated to treating pain aggressively could end your career. 

Why?  There are, in fact, bad docs who sell pain pills in huge amounts in their pain clinics. There also exists greedy pharmaceutical companies that misrepresent their products and pay bad docs to overprescribe their medications.  Because of the sins of the few, many suffer.

“Chronic pain patients” are a real pain to treat.  They have to be seen on a regular basis. They aren’t happy about having to be seen regularly and they let you know it.  Their medications require extra paperwork and are monitored by big brother.  They tend to be broke emotionally, physically and financially as many have trouble working due to both the pain syndrome and its effect on their ability to work.  They suffer and sometimes take it out on those trying to help them.

On the other hand, treating “patients with chronic pain” can be emotionally very rewarding.  Goals can be set and reached in most cases. The effects of your treatments are easily assessed in how functional and happy your patient is once treated.  By controlling your patient’s pain, you also improve his family’s life; and, in some instances, you are able to get your patient back to work.    

Unfortunately, the sad truth is many of my colleagues are afraid to prescribe narcotics and push chronic pain patients out of their practices.  Please note that, in the paragraphs above, I refer to “chronic pain patients” and “patients with chronic pain.” There is a difference!  And that’s why I’m angry.  There shouldn’t be!!

Patients with chronic pain need care and get care from caring physicians!  If the physician sees them as chronic pain patients, they don’t get care, they get the boot!  That’s just plain WRONG!


I’m also mad at my colleagues. I understand their fears, but they can’t let fear stop them from caring for patients in need.  One of their fears is that a few bad apples may slip through their defenses and get their hands on meds they shouldn’t have.  That’s the risk a physician must take in order to serve the greater good: caring for those who are truly in pain. (I’ve seen some great actors in my day and been fooled more than once. That’s a story for another day.) 

I’m mad at myself.  Right now, some of my former patients are suffering in pain and can’t find a physician who will care for them.  I should be there for them and I’m not!  Unfortunately, there is nothing I can do to help other than write an article that will never get into the hands of the docs it’s meant to influence. (And, for sure, never change the governments stance on pain meds either.)

Feel free to share this with your doc.  If he actually reads it, you are probably in the right place.

Here’s your music for today ad a joke.

One morning at a doctor’s clinic a patient arrives complaining of serious back pain.The doctor examines him and asks him:

“Tell me what happened to your back…?”

The patient replies: “Sir, I work for a local night club. This morning I went to my apartment early and heard some noise in my bed room.

On entering I knew someone had been with my wife and the balcony door was open.

I rushed out of the balcony door and did not find anyone.

As I looked down from the balcony I saw a man running out and he was dressing himself.

I was very angry. I grabbed the fridge and threw it at him.

It was very heavy…

That is how I strained my back.!”

Later that day, a second patient arrives as if he has been in a car wreck.

The doctor said: “My previous patient looked bad..

But you look terrible..

What the hell happened to you ?”

He replied: “You know I have been unemployed for a while now.

Today was the first day at my new job…

I forgot to set my alarm and I was late…

I was running out of the building, getting dressed at the same time.

And you won’t believe it but I was hit by a fridge.

I don’t know how and where from this fridge fell on me…!!!”

Before closing hours, the third patient comes. He looks like he was punished in hell.

The doctor is shocked.

He asks: “What the hell happened to you..??”

The patient replies:

“Well, It started like this, I was in a fridge……….

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2 Replies to “I’M MAD”

  1. Yes meds are becoming big issues. Meds we have been on for years are now requiring prior authorization, and not narcotics! Lavaza (fish oil)one you put us on over 15 years ago is one totally ridiculous!
    Even after 5 back surgeries for ray they give us a hard time about meds, plus they want to do another surgery. He says no way in hell.
    So we are right in that ‘mad group’ with you

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