I had to sign an pain management agreement with my PCP... is this normal?
Question posted by chronicpainhurts on 13 Feb 2010
Last updated on 4 May 2023
I had to sign a pain management agreement with my PCP which says that I can't get pain meds from any other Dr, even a pain mangagment specialist. I asked them, even if I get in a car accident, and they give me IV pain meds, and I am out of it, does that count and will they put me in rehab? They said "maybe, if they do not call the dr ahead of time"
Now, if I am semi-concious, can they do that? They said even if they SEND me to a pain management specialist, the PMS cannot give me pain meds... what? How the hell do I get around this one? I don't want to Dr shop, I just want the best Dr that will give me the best care, which would be a PMS... so why even go if they send me? If they won't let him do anything?
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72 Answers
SA
sara12345
27 April 2023
My situation is very different from everyone else I think. I have been getting opioid patches, Butrans or buprenorphine for at least the past 10 years from a neurologist at a major University. No contracts to sign ever. Twice I think I have been tested with a urinalysis to see if I was taking anything else. The last one my PCP ordered it--not the neurologist prescribing it. For the past about 5 years I have been reducing it from 15 mcg to now 6.83 mcg. And each time I would reduce it, my neurologist would tell me not to do it. I think that he thought that I wouldn't be able to stand the pain that I was taking it for. My whole body would hurt for about a month, then it would go away. But this last time, when I was reducing it to the lowest level patch, 5 mcg, I got the worst effect--akathisia. Absolutely horrible. That is a known side effect that can occur from REDUCING it. It creates a strong tension in the body so that you can't tolerate to sit or to lie down.
So to reduce it more gradually I have been cutting up another patch to add to the 5 mcg. That's why I am taking such an odd dose of 6.83 mcg. It's just as well that I am trying to get off of them because my neurologist thinks that I am the only one at the clinic getting these patches prescribed!! And my doctor is going to retire in a year or two. Terrible the fear that these doctors have to get into trouble for prescribing them. People do need pain medication. I read where the patches lose their effectiveness over time. The biggest reason for getting them was because my stroke caused 24/7 migraines that would get so bad that I would have to go to the ER about every 3 weeks. The neurologist hated what I was given at the ER. Thought the patches were much safer. Now Aimovig has greatly helped my migraines. But the patches were also to help my fibromyalgia. I have to sign for my Klonopin prescription when I pick it up. That is for an unusual movement disorder called myoclonus, caused by my stroke. It is usually given for anxiety, but doctors are also afraid to prescribe that one. Yes, it causes dependence on it, but I have been taking the same lowest dose of it for the past 14 years and have never had to increase it. Things have gotten so crazy in this country. It is really a shame. I feel for people who need medication for their pain and can't get it.
Votes: +0
DE
DeniseVaradi
29 April 2023
I’ve read that buprenorphine can be helpful for pain (I was just prescribed Belbuca which has a small amount of it) and apparently even that can be very difficult to get off of once you become dependent on it and the withdrawal lasts a very long time. I’ve heard that tolerance can build quickly and I don’t think I can start the medication. I need a better option.
SA
sara12345
4 May 2023
When I just looked up Belbuca, it looks like it is completely buprenorphine. I wonder why you are not getting the buprenorphine patches instead? That would be a safer way to get the drug. If you need it for pain, I wouldn't be put off by the dependence on it. The withdrawals were not bad at all. Had all over body pain, but it always went away completely within a month. That is NOT a long time. (But how you would do it with a buccal film is beyond me.) That withdrawal pain was nothing compared to the pain that I was getting that medication for. It didn't build up tolerance in me--maybe many years later. The way that I was able to reduce it without the pain getting worse, was through acupuncture. So you might look into that instead. But different acupuncturists are better than others. That was more effective than Botox. Find an acupuncture place that has "community" in the title of it. They are relatively inexpensive. I think that getting akathisia is not common.
I don't know what level of pain you are dealing with, but your quality of life is important. I hope that I was maybe a little bit helpful to you. You take care.
DE
DeniseVaradi
4 May 2023
I thought the buprenorphine patches were also completely buprenorphine. I also was prescribed Belbuca because it’s specifically FDA approved for chronic pain and it’s a low dose that I could have still taken my oxycodone with. I just needed a long acting medication to go with the short acting oxycodone I’m taking. But I took it once this past weekend and it made me feel too weird. Anxious and sleepy at the same time and I called the on call pain management provider who happened to be the PA who prescribed it for me and she heard how badly I was feeling from the first dose and told me not to take it again. I have my monthly pain management appointment in a week and was told we would discuss a different long acting medication then. I’m finding that I’m more sensitive to medications lately and having more bad reactions when I try a new one, even if I’d taken it years ago without any issues.
Yes, unfortunately. It is the norm for every patient receiving any pain management to have to sign a pain contract. Most have to do talk screens on a very regular basis to make sure the drugs are in their system and not being sold. Your question makes me think that you’ve not had to be very politically involved in what is going on in this country relative to pain medications, opiates in particular. There are many groups that both educate and advocate if you’re interested in becoming involved. There used to be some pill mills where doctors were simply prescribing meds for money. It was never the norm and it’s not happening now. Patients are being cut off without tapering, doctors are having their practices closed down by the DEA, others, who are only guilty of the crime of trying to alleviate pain in a responsible fashion are now imprisoned.
I can’t imagine the situation you described where you would be penalized for having been in an accident and possibly not even being conscious and being given meds. Still, given the current climate in this country, it behooves you to be proactive. Make sure all your practitioners know you are on pain meds, know who your pain management person is and that you have signed that contract. I carry a list of all my medications and the prescribing doctors and their contact information in my wallet. There is a false narrative going around that, unfortunately, many, if not most, physicians believe.… they believe prescribers are the cause of the “opiate crisis“. In reality, prescriptions have gone down in number exponentially over the last many years, while overdose deaths have increased exponentially. Even the CDC has admitted to messing up with its guidelines. This has become absolutely political, and you have to dig deep to find the truth. But the truth is out there and the truth is that it is the illicit drug trade that is the cause of this “crisis“ and ever increasing overdose deaths. Good luck. You are not alone, but it’s a pretty crummy feeling to know you’re a responsible person, using your medications as you should and are being targeted. The pain contract protects your doctor. Like it or not, these doctors need protection right now. Their liability is high, and the DEA is after as many doctors as possible, regardless of their legitimacy.
Votes: +2
JA
jammark
21 April 2023
This is not uncommon in Florida among doctors who prescribe opioids. They do have to be specially certified in order to prescribe opioids, so in a manner of speaking this is a way of protecting themselves but also protecting you. I have signed a couple and have never encountered a problem. I certainly do not think that if you were hospitalized and required pain medicine there would be any conflict or issue. That is an emergency situation. As you know, many people abuse prescription opioids and attempt to go to multiple doctors and utilize other methods to obtain their drugs. So this is also presumably, and hopefully, a deterrent to those who would abuse the health care system and prescription drugs. Unfortunately, this is the price many of us who need pain medicine have to pay because of those who would abuse substances. I don't particularly agree with signing these forms, but if I must sign in order to manage my pain then I will.
Votes: +1
GG
ggeolas
21 April 2023
I have had to sign an agreement like what you did but it was no way as restrictive as what you have described it simple stated that if I went to any other Dr or ER I had to reveal the medication I was on and that I was in a pain mgt program the other stipulation was that I could not receive any other pain medicine from another Dr if so I would be discharged from that clinic that is all nothing else I believe your Dr is being unnecessarily strict
Votes: +1
SM
smchurch
21 April 2023
Yes, this new system which was created by the "Quasi-FDA/CDC Opioid Epidemic Rules" has certainly made life difficult for true chronic pain patients to get the care that they need! Unfortunately, we have no options, and must just go along with their mass hysteria - regardless of it not curbing the death rate from overdoses by people that are just playing with drugs for fun! I feel for them, due to their misguided intentions of having fun now turning their lives into chaos - their now needing the drugs just in an attempt to try to get back to normal again! The truth is that only an extremely small (i.e., 2-5%) number of the approximately 50,000 (U.S.) chronic pain patients misused their medications, but now we are being punished for the actions of others!
Thus, meanwhile, our only option is to attempt to work with the new system, and unfortunately signing "pain management agreement" is only a minor inconvenience in comparison to many people that have been shut-off completely! Things will change eventually, but probably not in our lifetime; one Doctor told me that the pendulum swung too far, and that eventually it will swing back! I feel for you, but again, our only option is to work through this new system the best that we can! Sincerely, and wishing you the best in finding adequate relief, smchurch
Votes: +2
DE
DeniseVaradi
29 April 2023
Good points. We are lucky to have providers who make us sign contracts for the medications we get because a lot of pain management doctors are not prescribing anything anymore. And it’s true that pendulum has swung too far in response to others” problems. I understand addictions, have struggled with other kinds myself, but it’s not fair that we are suffering as the government tries in vain to fix their problems. You can’t stop addicts from getting what they want, can’t save them from themselves. They aren’t stopping the overdoses from the stuff on the streets by restricting our access to legitimate pain relief.
IN
Inactive
21 April 2023
Know the question is old, but I had to sign one for Lyrica, an anti convulsant for neuropathy. It kind of seemed stupid since it's not an opioid. But if I didn't, I would have been high and dry on my Lyrica prescription. This was from my PCP. I saw a neurologist for 3 years and never had to sign anything like this.
Votes: +0
BR
brambo
3 Oct 2020
No in an emergency they should not do that! But most PCPs won’t touch pain management do u are lucky! All pain providers require contracts. If you get dropped just ask for a referral to pain management! And yes you can get meds from pain management if they drop yours! Find a new PCP then!
Votes: +1
AD
Ade777
9 July 2020
I feel for you. I am in the exact same boat.
Votes: +0
LH
Lh50
16 April 2019
I too, have a pain management doctor and had to sign that same agreement. What I did was, made a medication list, the drugs name, the mgs., how often I take it. At the top of the list I put my primary doctors name and phone number, my pain management doctors name and number and I also put what my autoimmune diseases are. My children know that if something happens to me and im not conscious, they too, are to make sure the doctors and nurses know im in pain management. This might work for you too.
Votes: +1
GD
gdcrosser
18 Aug 2018
I signed a similar agreement. But there are no stipulations for emergency care. They just want to make sure they are aware of the situation after I am healing. Check with Dr. on this. Thanks
Votes: +1
WI
Windchimes123
3 Jan 2017
Hi Chronic, You are being bullied. Yes they can do it. You do have the choice of going to PM and if you prefer their treatment, sign a new contract. You will no longer be able to go back and expect pain meds from your Primary. The bullying part is in response to you being in an ER and semi-conscious. They probably wouldn't give you pain meds with an altered mental status anyway. I got even when I got the "no pain meds ANYWHERE response". I had an unrelated pain emergency. I waited until the middle of the night to go and insisted the ER call him at 4am on a Sunday. His response "of course you can get meds in the ER! You woke me up!" Lol... I went on to explain I'm just following directions because I wanted to draw out my time talking. It felt good!
These contracts ARE legal documents. It's time lawyers develop a specialty to handle this issue. It would be worth $100 for the doctor to know there is a lawyer involved. They hate law suits more than governmental threats.
You a not doctor shopping. You are a dissatisfied customer. Best wishes :-)
Votes: +2
IN
Inactive
3 Jan 2017
AMEN Sister
WI
Windchimes123
3 Jan 2017
Hi G, Happy New Year ! I'm so sick of these doctors who wish they were policemen! I can see there point with government threatening them but they allowed this to happen. The AMA should have stood up for their profession. :-)
IN
Inactive
3 Jan 2017
Wind chimes: Hey Girl! Happy New Year back at ya! Roll Tide!
WI
Windchimes123
3 Jan 2017
Lol... Congrats on a winning season ! We still have football going on now. He's banned to the office to watch it! Are you doing well ?
Back to business... I'm surprised with the crowded profession of law that they haven't picked up on the need. Sure there are med-mal lawyers but this type of thing doesn't require anything complicated. All people are asking is to be treated humanely. I understand the long term effects of opioids but complications of untreated pain may shorten lives anyway. I just don't get it !
IN
Inactive
3 Jan 2017
Wind chimes: Hey Girl! Two of my previous comment were flagged "pending approval". Funny world huh? Ok, yes I agree with you totally with how the system is unfair to patients when it comes to pain management, and getting worse with each tick of the clock. So I just drown my sorrows in watching my favorite football team go for their 17th National Championship. Roll Tide!!!
WI
Windchimes123
3 Jan 2017
I wish I had a list of flag words. It happens to me also. I was thinking of you when the game was on. I knew it would make your day!
ST
Stephen Treloar
3 Jan 2017
I've had some posts not posted "pending moderator approval". The annoying thing is I contacted the Admins and they claimed it was my spelling (I'm illiterate apparently). I got annoyed so started saving every post again and reposted a post which had not been approved and it went up instantly. Their human moderators are completely useless or just plain don't do any work at all (I have a vision of a bunch of crackheads saying yes or no depending on how high they are).
IN
Inactive
3 Jan 2017
Lol
WI
Windchimes123
3 Jan 2017
You changed my visuals, Stephen ! Lol I get so frustrated after taking the time to write the comment and it's squeaky clean. I never bother to rewrite and that is shame. Thanks for the laugh! Happy New Year !
IN
Inactive
3 Jan 2017
Wouldn't this be a good time to post a NEW QUESTION concerning this topic and start a new thread? This one has gotten a little long in the tooth! (Roll Tide!).
WI
Windchimes123
4 Jan 2017
Wow!!! It sure has... I've tried to bring it up but gets sucked into the black hole of pending approvals. Too political? Lol Ok bye thread
I have also take pain meds ,but I read the three sheets and didn't agree and walked out. I refuse signing because I am always giving info to my dr. It's a control factor with the government and Dr have alot of paper work to fill out be prescribing opioid. So sorry you got backed up, don't know what type of medical you have fill a complaint that's what im about to do. Good luck Nancy
Votes: +0
IN
Inactive
3 Jan 2017
AMEN Sister.
MO
mommywoman
9 Aug 2013
I don't have the answer you are looking for, but I also had to sign the same agreement.
Votes: +0
JO
johnw489
17 May 2013
Yes it certainly is normal practice to protect themselves and hopefully catch abusers. I am just starting my 50's and have never even drank alcohol. I played loads of sports and am paying for it now. My doctor even asked me to take a drug test the same day she gave me pain medication?? hope you feel better.
Votes: +0
GA
gaormsby
13 Feb 2013
I had to sign an agreement also. But two back surgeries later where I keep the dr. informed there was no problem.
