Re: chronic pain patients and pain agreements

[Guest guest]

Dear Dr. Lyon, I was excited to see your return address and the headline of

subject , with reference to chronic pain patients, as I find your writing

especially wise and often witty...However, when I tried to open your

message, all I found was a blank page ! I hope you didn't get a spiked glass

of champagne... was your message interrupted, or lost in the ozone?

I would mostly wish that my own patients with chronic pain who need

these Schedule - 2 narcotics could be working in some sort of teamwork

fashion with a specialist in a chronic pain clinic, and me as the family

doctor being sort of the co-pilot... but, I am encountering a series of

barriers. When that consultation finally happens (in the rare circumstances

when I can push hard enough to make it happen, ) the patient comes back

telling me that the specialist only talked about epidural injections, and

they have been so resistant to the concept of needles going into their

backs, that they never go back for a second visit...I suspect that this

resistance may contain some element of Addiction to the narcotic fog, to

which they have become accustomed, but I am essentially left holding the

bag, with a slippery grip. I am not really certain that making one of these

patients sign onto a narcotic-contract is going to make any difference to

him/her, or to me, but I suppose there will sooner or later come a time when

one of those patients breaks one of the hard rules, and then it will be

easier to discharge him/her from my practice... Also , I want these patient

to know that I take the whole matter of my D.E.A. license, and the task of

controlling the Controlled Substances, very seriously. Maybe it will reduce

the likelihood of diversion, and the terrible consequences to which that can

lead ...Rian Mintek, M.D.

chronic pain patients and pain agreements