Levels of pain cannot always be measured by behavior.

Unless you are culturally competent you will always make a mistake about whose being honest and whose faking.

There a numerous types of cultures including the cultures of gender, child abuse survivors, domestic violence victims, etc.

Facts based on bias must be considered erroneous. It is easy to make facts fit ill conceived presumptions. Once a doctor believes a patient is drug seeking they stop investigating any other illness. My hyperthropic cardiomyopathy was undiagnosed because they believed I was a drug addict

1. Undiagnosed heart disease can cause a decreased heart rate. I suffered from severe pain due to autoimmune pancreatitis. My heart rate was 58 bpm. I was beginning to have an adrenal crisis, but that was ignored because they believed I was a drug addict. I was so weak from dehydration that I could barely take my clothes off. They told me they were going to cut them off. When I finally did take my clothes off that was their proof that I was looking for drugs.

2. Patients become more comfortable when doctors that are disbelieving, condescending, and abusive are no longer interrogating them.

3. There are people that eat because of the stress of their pain or they are hungry. Statements like “milking a food tray” are definitely evidence of bias. Something very basic like addressing someone’s hunger is what civilized society’s and people encourage.

4. Medical tests like fMRIs are only useful if those who are interpreting them are free of bias and are also competent. I had an pituitary tumor it was ignored. My pituitary ruptured and I had blood in my spinal fluid they said it was a migraine and sent me home. MRI showed an empty Sella, CT showed an empty Sella the abnormality was ignored. I almost died due to an adrenal crisis, before I was taken seriously. I was sent home from the ER with life threatening complications (adrenal crisis) and collapsed in my PCP’s waiting room with a blood sugar of 34. At that time, I wasn’t taking any pain medication. It is worse now that I am.

Women in childbirth are taught not to cry out in pain “lose control”. This “training” carries over to other painful disorders.

When I was a child my aunt would punish me by beating me with a switch, belt, and one time a broom. My aunt would yell shut up every time I cried out in pain. The beating would not stop until I stopped crying. That meant every time she hit me and I cried out the beating would continue. She stop hitting me after I stopped crying. Then I had to prove I wasn’t going to cry anymore by enduring several more hits without crying.

Is it any wonder why a patient like me would not cry out although I am in tremendous pain. I controlled my pain by sheer will power and I am blessed that I am still alive.

It is basic human instinct to maintain silence and control when in the presence of danger. In an ER, where doctors and nurses abuse patients that take medication for chronic pain, danger exists. I have been abused and treated like an addict although I wasn’t taking pain medication.

My illnesses are ignored because I take pain medication. I have been sent home with a blood pressure of 235/107, no treatment was provided.

My medical illnesses, adrenal insufficiency, require me to go to the ER when I am ill to prevent an adrenal crisis. More often than not I have been denied care, viewed with suspicion and interrogated. These incidents happened when I wasn’t taking pain medication.

Statistics show that 4 out 5 patients are not addicts and to state otherwise is a “fallacy of distraction”. Characterizing those who disagree with you as unintelligent is another fallacy of distraction; when all else fails attack the person.

These actions show a considerable lack of critical thinking.
What makes you all knowing. I was accused of being a drug addict. I was referred for a steroid injection. Based on my race it was automatically assumed that I was a drug addict. Whether it was conscious or unconscious racism, I was denied medical care because of bias. Although they issued a written apology, I have never forgotten the humiliation of having my body checked for needle marks and being interrogated like a criminal.

Drug addiction is a disease.There are worse addictions. Diversion of Viagra and the passing of AIDS, Syphilis, and drug resistant venereal infections to innocent partners. Child molesters and pornographers arrested while having Viagra in their possession, but no one complains about the abuse and diversion of this drug.

Just because you are doctors, while we choose different professions does not make you all knowing and powerful.
You remind of the doctor who became angry when my mother said she wanted to live as long as possible. She refused to agree that her life was no longer worth living. He believed she should just die.This man should never be allowed to practice medicine nor should you.

Too many innocent lives are lost because of doctors like you. I have met doctors like you. Bias and prejudice ruled their decisions while my medical illness was allowed to fester and now I will die an early death. Find another profession.

Oath of Maimonides

The eternal providence has appointed me to watch over the life and health of Thy creatures. May the love for my art actuate me at all time; may neither avarice nor miserliness, nor thirst for glory or for a great reputation engage my mind; for the enemies of truth and philanthropy could easily deceive me and make me forgetful of my lofty aim of doing good to Thy children.

May I never see in the patient anything but a fellow creature in pain.

Grant me the strength, time and opportunity always to correct what I have acquired, always to extend its domain; for knowledge is immense and the spirit of man can extend indefinitely to enrich itself daily with new requirements.

Today he can discover his errors of yesterday and tomorrow he can obtain a new light on what he thinks himself sure of today. Oh, God, Thou has appointed me to watch over the life and death of Thy creatures; here am I ready for my vocation and now I turn unto my calling.

Pain is inevitable, suffering is optional.
Veritas

“This is a perfect illustration of how doctors dehumanize patients…”

That’s funny and ironic, because that sentence is a perfect illustration of the way unintelligent people generalize when confronted with a situation they either cannot grasp or lack the perspective to view fully.

There are people with real pain. And there are people who use drugs for gratification, as well as a spectrum in between. You stand at one end, and you’re unwilling to admit the other even exists.

I generally know when people are honest and when they’re faking. But I tend to treat the fakers, because maybe the end result is a good thing. Drug abuse seldom stagnates–it spirals out of control. So maybe I’m helping that person weed himself out of the gene pool. I’m thrilled about that.

That said, here are some things to remember:

1. Someone with 10-out-of-10 pain, does not have a heart rate of 75 (without being on a beta blocker, or other reason for adrenergic inhibition)

2. Someone with 10-out-of-10 pain does not become visibly more comfortable when he or she thinks no one is watching.

3. Someone with 10-out-of-10 pain is generally not interested in milking a food tray out of his fast-track visit.

Someday, we’ll be able to use fMRI’s to determine accurately who’s lying, and prosecute them with extreme prejudice, like the felony it is. Cheers!

I have recently found out that when I went for a stress test a few years ago, that I was labeled a drug addict by the “nurse” administering the thallim stress test.

I am confused as the best way to rectify this.

Twice at two hospitals I have been refused treatment and labeled a methadone addict thanks to a long gone pain management specialist.
First he put me on this then the same pain doctor removed me from the methadone do to reactions, and put me on morphine sulphate.

After he kicked me to the curb my regular doc put me back on it and will not take me back off. I am assuming this is do to the label. Yet he knows me twenty years. His answer seek another pain management specialist.

How in the name of god can some professional administering a stress test label me and I not find out for several years.

For starters all files should be signed by both the patient and attending person to avoid this type of conflict.

I mean I had a hard time for years until I finally asked them why I was treated like shit. Then he told me.

Redhawk is right and you folks give yourselves away when you jump on him.
Pain severly affects ones emotional state. Perpetual stress 24/7. logic dictates that it will have a major effect over time.

Any you folks expect him to be nice when the feelings are not reciprocal.

LOL

Thanks for an excellent and inciteful post, Anon.

I have been the contact person for a few chronic pain support groups for over 13 years. In this role I have heard literally hundreds of stories from people in chronic pain, in addition to those I have read on the internet and elsewhere. I have never spoken to a single person with chronic pain who doesn’t have a horror story about abuse from the medical profession, with ER docs being the worst offenders. I wouldn’t send a dog I didn’t like for pain treatment in a typical ER.

The most common forms of abuse are rude, arrogant behavior from doctors and their staff, acccusations of drug seeking or addiction, manhandling during physical exams and minimizing or outright dismissal of pain problems or being told the pain is all in your head, and of course, simple denial of effective pain treatment.

These are just some of the milder abuses I’ve heard. The more criminal ones involve women being pressured into having sex or risk losing their pain meds, doctors screaming in their patient’s faces or groping them during exams, and doctors lying and using scare tactics to get desperate patients to have unnnecessary or highly questionable surgeries.

When patients react to all of this abuse with anger and distrust, they are then labelled as “difficult patients” or as having “personality disorders” and it is not uncommon for patients to have their medical care sabotaged by being blacklisted to where no doctor will treat them

And of course there are the ubiquitous “script doctors” who charge $500 to $1,000 a month retainers in exchange for prescribing anything a legitimate patient or a junkie could want. These are the guys the DEA is after, but every doctor is terrified he could be next on the DEA’s hit list so they avoid prescribing pain meds like the plague.

Although there are plenty of good doctors out there who treat their patients with dignity and respect, and lots of people can and do receive adequate and compassionate pain treatment, it is also true that there is a tremendous amount of abuse and exploitation out there as well, and you can readily see the kinds of hostility, ignorance and arrogance directly underlying a lot of that abuse right here on these medical boards and blogs.

Really? Considering the rate of addiction among cp patients is actually rather low, I’m curious where you’re getting all these “seekers” from? Do you have some sort of infallible technique for discerning people who are seeking drugs for pain from those who are seeking them to get high, or do you just have a biased attitude towards people in pain?

The reason I ask this is that it is a common complaint among people with cp that they are falsely labelled as addicts and denied pain treatment, and I cannot begin to describe the sheer psychological stress this causes to a lot of patients, who see it as a betrayal of the trust they put in their doctors. Most doctors have a tremendous amount of bias and hostility towards people with pain, and I supect that this bias manifests itself with false accusations of drug seeking as well as in the false perception most legitimate pain patients are drug seekers.

Beyong that, it is a very self-serving rationalization for a doctor who is afraid to prescribe pain meds to imagine that he is actually doing his patients a favor by not indulging their alleged addictions, rather than having to face his own moral cowardice.

This is complete nonsense of course, as pain is far more destructive than any addiction, and a lot of the damage drug addicts experience is caused by the constant cycle of use and withdrawal they experience due to inconsistent supplies, so you’re not doing a junkie any favors by forcing him to go through withdrawl or having to rob someone to pay for his fix that night.

In the UK and Switzerland they are beginning to treat heroin addicts with maintenance doses of heroin, and the result has been a dramatic improvement in health and functionality among hard core addicts and a decrease of criminal and anti-social behavior.

Seems like aggressive treatment with opiates is the best option for both those in pain and those who are addicted.

To leave hundreds of chronic pain patients suffering from severe, intractable pain in order to avoid giving a junkie a free, clean high is destructive both to people in pain as well as the junkie. It is morally indefensible.

Adopting such a smarmy, condescending attitude would elicit anger in anyone, chronic pain or not. If you’re like this with your patients, it’s little wonder a lot them get pissed at you.

It is significant that you didn’t address a single point I made in my post or the issue of medical blacklisting, which is blatantly unethical. Instead, you chose to psychopathologize me as if my “anger and passion” can only be the result of some shared fundamental character flaw common to people in chronic pain, rather than a reaction to the abuse most people with pain are subjected to by the medical profession. How charming.

This is a perfect illustration of how doctors dehumanize patients, where any overt expressions of pain behavior are labelled as malingering, factitious disorder or drug seeking, and even the mildest expressions of anger or disagreement are seen as evidence of a personality disorder or a rage disorder. Alternately, if you don’t show pain or are too passive, you will be told you can’t possibly be in as much pain as you claim to be in. You will rarely be treated as a human being having a predictable human response to an extremely stressful situation.

I’m not exactly sure what “harm” you are talking about with narcotics. Taking as directed, they are the safest and most effective treatment for most kinds of pain, and there is no evidence of organ toxicity from narcotics. As for addiction, the rate of true addiction to narcotics in pain patients treated with them is less than 1 to 3 percent. The NSAIDs and other drugs doctors hand out like candy are far more dangerous, and many drugs like Paxil or benzos far more addictive in terms of trying to get off them.

You seem unaware that having to endure severe pain and its attendant stress on a near continuous basis for yearscan be pretty damned harmful as well, and many people end up totally disabled for life due to the destructive effects of untreated pain. So I suspect the “harm” you are seeking to minimize is not your patient’s, but your own.

A couple of anecdotes are in order here.

Many years ago I had a carpool arrangement with my father, a cardiologist. (I had a physics postdoc position at the time.) Every day we’d ride in to work together and I’d drop him off at his office across from the hospital. Then in the evening I’d go to the hospital and wait for him to finish his evening rounds. I either waited in the ER or in the doctor’s lounge right next door. Sometimes the wait was for only a few minutes, other times it was several hours.

The net result was I ended up spending literally hundreds of hours in and around the ER watching what went on without participating. I saw plenty of drug-seeking behavior there, but I also saw quite a few instances of callousness and even outright cruelty on the part of doctors towards some very sick and desperate people.

Some years later I started having serious abdominal pain. After one episode in the fast lane of I-10 where it was all I could do to get my head out from between my knees and keep driving, I went in for some tests. The verdict: Gallstones. A cholecystectomy was needed in very short order, followed by a five week hospital stay – fairly serious stuff.

At one point during the stay my GP stopped by. He glanced at my chart, frowned, and left the room. A few minutes later he was back and announced “I’ve called your surgeon and he has agreed to increase your pain meds.” I was a bit puzzled by this because while I was far from comfortable I was hardly screaming in agony. It was only after the larger dose kicked in that I realized I had been in considerable pain all along and I had just gotten used to it. I asked my GP about it later and his response was “your surgeon is a nice guy but he has never been sick a day in his life and he just doesn’t understand pain”.

So what’s the bottom line? The bottom line is that pain is unfortunately a subjective thing both for doctors and patients, and any time something is this subjective there are going to be mistakes and misrepresentations.

But the one thing that has no place in any of this is the arrogance I see in far too many postings by physicians. Remember that when “4 out of 5 people asking for pain meds are just after the drugs” it also means that 1 out of 5 do need the meds, and like it or not you’re going to make mistakes sometimes.

It would certainly be nice if pain could be placed on an objective footing. Someone really needs to invent the dolorimeter I recall seeing in one of the original Star Trek episodes. If such a device existed I’ms a bunch of people would end up cut off from their drug supply, but I also suspect a bunch of doctors would be aghast at what they’d done.

In addition I meet many people that have come to the realization that they have become addicted to vicoden who always blame the doctors they saw as “getting them hooked”

Relieving pain is one of the most satisfying thing that I can do as a doctor. On the other hand, enabling the addict perpetuates self harm and is not my duty.