Does anyone know how to get out of the contract my PM doc made me sign? Here's why:
Saw PA for herniated disc with DDD some time in 2006. Was prescribed Norco, which I used 3 a day for a few weeks, and PT, chiropractic, acupuncture, breathing/relaxation, and eventually I felt better so stopped the Norco. I continued with the PT at home. Some time went by, I'll have to guess here, but I think it was several months and had another flare up, went back on Norco for a few weeks, then stopped. Up until May 2008, I didn't have too many issues with flare ups, then we moved. I had to do most of the move since my husband had to work, so I packed, loaded, unloaded, everything but the furniture (took me two weeks).
Slowly my back started aching, so I took it easy, but one evening pain level went through the roof and I ended up in the ER where Dr. administered dilaudid and a script for Norco, then told me to make a follow up appt. with PA, which I did, he gave me more Norco (yes, I told him the ER had given me and how many).
Well, this flare up was much worse than the previous ones, and it was unrelenting, chronic, high pain (about 8 or 9 on pain scale).
I went back to the PA and he ordered another MRI, then referred me to a surgeon. I went to surgeon and he said I have to have surgery right away, and ordered me to set up an appt. for it. Or...I could try an epidural if I wanted to, and then he told me to stop taking the Norco and replaced it with Neurontin, which he told me was a non-narcotic pain reliever (which I know now is not approved by the FDA as a pain reliever, so he was wrong to tell me that). The neurontin really screwed me up, I lost my balance a lot. I guess it works for some ppl, but I am not one of them.
Anyway (thanks if you're still with me, I know this is a bit lengthy), I called PA back and he sent me to their PM doc, who was great. He said "I think you can get over this, so I'm going to keep you on 3 Norco a day, and come back here in a month."
That was a little over a year ago. PM doc also put me on Lyrica and Ambien CR. His logic (which makes sense to me) is that when your body gets enough sleep, *real* sleep, for 10 hours a night for at least two weeks, sometimes the nerve will settle down. I was told not to do my PT, b/c it really hurt to do it, and to increase my swimming time, which I did.
As time passed, this Dr finally did an epidural on me - two weeks later I still had no relief, so he sent me to a different surgeon who works in same bldg., to talk with and see if I need surgery. "Yes, you need surgery. Here's what I will be doing, and I will make sure not to ruin that tattoo on your back. I do it all the time" I didn't even care about that, I just wanted to be out of pain, but COOL (it's my marriage tattoo, lots of sentimental value there).
I scheduled surgery for Aug. 18, about one month away, b/c I had to find someone to help me while my husband was at work. Two weeks later my brother calls (he lives a few states away), and I go into this story, and he says "I had a epidurals, first one didn't work, second one I was pain-free for almost a year." I decided to get appt. with surgeon to get his opinion on what I should do. Surgeon says "If you want to try another epidural, let's do that, anything to avoid surgery." Great! So I got the second epidural and not only did it not take away my pain, it made it worse (three weeks later).
I then decided I was going to have the surgery, so made another appt. with surgeon to get the ball rolling. Man, was I surprised when he said he was not sure I'm a candidate for it. Huh? My question to him was "what am I to do? I can't keep taking pain pills forever", and I started to cry, not hysterical, no angry, just frustrated. I was never once rude to the surgeon, but he got up, said "I'm done here!!" and walked out in a huff saying "Don't worry, I'll fill your script this one last time, wouldn't want you to go through withdrawls now, would we?!" Huh? again. I was dumfounded. What just happened? I gave the guy two weeks notice before my surgery was scheduled, and had his approval for the second epidural. WTH? Then his PA came in and handed me a piece of paper with another surgeon's name on it "for a second opinion", and a referral to a different PM doc.
I saw the new PM doc last Friday. The Monday prior to that I saw the "second opinion" surgeon (who I really like), explained to him all the alternative therapy I'd had, he looked at my MRIs, did an exam, and said "I think you would benefit from surgery, but first I'd like you to get facet injections, and wrote out a prescription to the PM doc for the facet inj., explaining that if it didn't work, I was to go back to him for surgery.
In the exam room I was handed some paperwork to sign. I asked my husband to please get my glasses, and the PA (Dr was not in the room) said "Oh, you don't need to read it, it just states that you won't go to another doctor for another prescription for pain pills." I asked "Does that mean I won't be allowed to get assistance from ER if I need it, which I haven't in a while, but I want to be able to get relief should my pain go through the roof like it did a couple times this summer." Guess what? the PA said, "Oh, no, you can still do that."
Meanwhile, I have a friend who is a nurse, so I called her to inquire about the contract, and she told me "Um..no, you can't receive any help with pain meds from ER if you signed that contract. So I started doing some research and now I'm here.
Whew, did that all make sense? If anyone has any advice for me, I'd greatly appreciate it.
Morgana
after i signed i only take med that my pm or gateway doc write me i went to the er after i cut my finger half off 3 weeks ago and only got shots of pain meds no pills if i allrdy have pills from my pm and gateway doc why would i need more from the er its best to follow the contract or seek real legal advice if you need to get out of it but, ya if the doc that made you sign the contrat is no longer seeing you then he or she broke it then id think your free to seek pain relivers from a new doc or er
I had the same issue come up when I went to the ER. I didn't have my contract with me, but I was afraid I'd get in trouble if they gave me something there. The ER doctor assured me my doctor would be fine with me receiving emergency care in the form of pain relievers. While I was in the ER I gave in and let them give me pain killers. After that incident I spoke with my pain management doctor and she said that if I'm ever in extra pain and can't get anything from her office that I SHOULD actually be going to the ER. She said that the only other acceptable way to get any pain meds was to go to the ER since I signed my pain contract. One thing she did say though was that if I was written a prescription I had to call her and let her know the very next day. She did say that in the meantime I was fine to take whatever they gave me. For example, I brake my hand at 10:00pm and they write me a prescription for percocet. I get it filled when I get out at midnight, and I'm supposed to take it again at 4:00am. My doctor is fine with this. My guess would be that your doctor will be absolutely fine with you getting pain medication at an emergency care facility. I would also assume that your doctor will just want to know if the ER doctor writes you for a script above and beyond what you already receive, which shouldn't be a problem. Before you leave this doctor's practice call and ask about an ER situation and my guess is they'll tell you it's absolutely fine to get pain medications while under the immediate care of an ER doctor & they'll just want to know if you're written a prescription to take home.
kinda sounds like mine Kelly... my contract deals with only getting narc meds from my PM office unless it is a problem after hours. Then just need to contact them the following day to report what happened. If I have a problem/ major flare=up during office hrs I just need to call them first for guidance ( of course this dies not apply to emergencies such as car accidents or falls not relating to my PM visits)...... off visit or be told to go to ER... Gues this brings up a good ? unless it has been answered before.... Is a PM contract a legal binding contract or not???? leaning towards the side of no if documentation can be provided.. have a good day all
not unless a person is difinitely kinky, a pain freak
I think that the accidental loss of fingers or toes, hands, feet, ears or whatever maybe a gunshot or a stab wound would be ok, the majority of the contract covers the unforseen chronic pain management or everyday program, noone in their right mine will volunteer to amputate flanges to receive pain medication.
Woodstock, no Dr., just a hillbilly
i can not understand your post woodstock
asmmw- yeah, I think that's the way most pain contracts are, in that your PM doctor just wants the patient to avoid getting multiple pain scripts on a regular basis from multiple doctors. I don't think they're meant to punish us as pain patients and prevent us from getting neccessary care. I have a pain contract, but if for some reason my PM Doctor can't see me or for example I have a sugery (like I recently did) she said to just let the other doctor prescribe what he thought was best. Then once I had my script she just wanted me to call and leave a message to let her know what I had received. It's all about keeping your doctor in the know basically. That's a good question about the pain contract being legally binding. Unless there's some penalty written into the contract for violating it, I don't think there's really much legally that can be done. My contract basically says that if I violate it my doctor can discharge me from her practice. There's nothing in there that says I could be held financially responsible or even legally responsible as in violating some law or committing some crime. However, if a patient is doctor shopping or selling their medications, hence in violation of their pain contract, the law can step in and many doctors will turn in their patients for doing this. This is a crime with or without a pain contract though, so I again I don't think there's much a doctor can do other than discharge a patient for violating their pain contract. I don't even think it would stand up in court for a doctor to put something like, "If the patient is found in violation of this contract they will pay me $1,000 or spend 30 days in jail."
When you have a pain contact with a PM doctor or a PCP for that matter it is always a good idea to call your regular doctor if you are experiencing a drastic increase in pain related to the condition that said doctor is treating you for. When you call you can explain what is going on and you can let them direct you from there. Whether it be an extra script called in or "go the the ER" orders from the doc. If you cannot actually talk to or text your doctor after hours you can atleast leave there office a message that you are going to the ER because your pain is intolerable, etc., etc. This way when you call the doctors office the next day and either make an appt. to explain what happened, explain what happened over the phone, or show up in person and explain what happened including meds received from the ER doctor (be specific with meds and doctors names). You should also get whatever meds are received from the ER filled at the pharmacy you listed on the contract you signed, unless its a script for the meds you are already receiving from your pain doctor and in this case you should not get the scripts filled anywhere since this is the behavior the contract is trying to weed out. Receiving multiple scripts for the same meds from multiple doctors, ie. doctor shopping. All of this said, even if you try your best to be straight up and honest with your PM doc if your contract says you cannot get pain meds from any other doctor you could still get dismissed for getting pain meds from the ER for the condition that the PM doctor is treating you for. If you go to the ER for something totally unrelated like kidney stones, broken coccyx, extreme Dysmenorrhea, monkey pocks, etc. you still need to tell your PM doctor whats up as soon as humanly possible along with any pertinant information to cover your rear. As far as getting out of your pain contract, its pretty unlikely. Most PM doctors and even some PCP's are making there patients sign them now a days. It gives the doctor a false sense of security against the DEA for treating pain as a condition and not a symptom. It shows that even though they prescribe narcotics they are trying to make every effort to curb illegal activities.
Phalanges is misspelled in Woody's post. Not the only one, but it may be causing some confusion. Htmom
Thank you for the replies. I must have messed up somewhere in my original post. It was the *surgeon* who walked out on me (not the PM doc). Prior to that I was seeing a short-term PM doc, who was awesome. The first two surgeons I saw work under the same roof, they are a team. The first surgeon was impatient with me (I have ADD, but don't take meds for it), and he didn't really understand why I needed him to speak more slowly, also he isnot a native US citizen, so he spoke with broken english, and left out words, e.g. "Morgana, why you no work? You drive but you no work?" "You need surgery tomorrow. Go schedule it." Then he took my Norco away and replaced it with Neurontin, which did nothing for my pain.
OK, so I called the facility and told them what happened, and they had me see the short-term PM doc, who I liked a lot. It wasn't until I saw the second surgeon in same practice that he walked out on me, and I did not have a pain contract with this place. I was sent away with two names, one surgeon, and one a PM doc. They are not under the same practice, they are independant.
After some research about that contract I signed, I decided to call the new PM dr. back and ask specifically if I could, if needed to, go to the ER and receive help if my pain went to an 8. They said "No, definitely not. You can't get ANY pain medicine from ANYONE, including the ER. Now I'm really steamed. I have a lot of anxiety over this, b/c sometimes my pain leaves me lying in bed, writhing around (the nerve causes that), and I can't take anything for it. I think this is cruel.
Thanks again for your replies. I wish I had a PM doc who was a bit more lienent like some of you have.
Seems like you have not spoke with the pm dr about getting meds from the ER. I would ask the dr on your next visit and not his/her help. I think there is a misunderstanding some where. Because if that's the policy, I would look elsewhere for a pm. I also think that you need more or a different type of pain med to help keep the flare ups/bts under control. Just my opinion. Take care, htmom
I really appreciate it that you all took the time to help me.
Oh, and get this: Dr. tells me he needs to do X-ray of me bending. I hate x-rays, but ok, if it's only one or two, fine, I'll do it. I get there today, to the x-ray place, and they tell me to lay on the table. "Huh? What for? I'm supposed to be bending over", I say. "Um, no, we have orders for 9 x-rays." Ugh. I got upset and left crying. Then I started thinking about it, and knew I had to do it or I'm going to be refused meds.
I have a feeling I'm going to have to contact my attorney about this. I'll let you know what happens.
Thanks again, and Hugs
Wow, I'd do like htmom said. Sometimes office staff isn't really aware of what really is the policy. I mean, what if you were in a horrible wreck and lost a limb or something? Would they not expect you to get any pain medication? That's just ridiculous. I think most doctors understand that there will be cases where we need ER care as pain patients, especially if you word it to them properly.
If you really don't want to be under this pain contract, you just have to stop seeing this doctor. Once whatever meds you have from this doctor run out you should be fine to get meds from another doctor since you're not getting meds from 2 docs at once at that point. Of course, be sure to tell the new doctor that you've left the last doctor so they don't think you're up to anything.
if a Dr. orders x-rays, an/or lab work an You refuse, even if He s the best PM Dr. You ve ever found He can drop You for not complying with His orders, esp. lab. work.
Woodstock
You cut your finger off? I hope you got it stiched back on, and OUCH!
Yes, I agree that it is ridiculous that I'm not allowed to get pain help in ER. Ironic, but last week someone literally ran me off the road. She just changed lanes, didn't look, and I had to slam on my brakes so I wouldn't hit her, I swerved off the road, luckly there was grass where I ended up. My skid marks are still there. Imagine, God forbid, if something DID happen and I was in a lot of pain, it was 3:00 a.m. or off hours, what do I do then?
I think I'll have a field day with this PM doc b/c his staff not only grabbed the contract out of my hands, but she told me that I would be allowed ER visits so long as it wasn't every week. Good grief, who could afford that?
htmom: no, I haven't spoken with the Dr. about the ER, didn't think I needed to b/c his help said it wouldn't be a problem. My other complaint here is they made me leave my purse on their desk. Ok, so I'm supposed to trust them, but they are not obligated to trust me. I should have told her my bag comes with me to pee in that cup, and if she wants to follow me in there, feel free. LOL. Making light of this, my husband has a ??&@* thingy (I had to edit this b/c the word before thingy must be one I'm not allowed to use) . Ok then, flatulance thingy. You hide it somewhere, in my case, I'd have to put it in my sports bra, and when you push a button, it really does sound gross. LMFAO. Of course, I would never do that, but it would be rather hilarious.
Off topic I know but I've always wanted to bring one of those into a movie theater during a really suspenseful film and let it off right as the tension is building for a really scary part....lol. call it the 8 year old boy in me...
OMG I have one of those fa-rt machine things! My dad gave it to me! What's really funny is that my hubby's car door opener sometimes makes it go off, so if it's left on for some reason and my hubby unlocks the doors of his car all of a sudden I'll just hear this loud fa-rt noise and it'll freak me out cause when my cats fa-rt they're usually SBD's so I'm like what the heck was that?
went from contracts to fingers getting cut off to ??&@* machines? wow I am lost.
Some doctors are so burned out on patients that will not help themselves and want to be on drugs . He sounds like he judged you as in going from doctor to doctor to get pain pills. He didn't take you at your word that you were doing all you could to make the right decision. I am so sorry.
The contract you signed , I had to sign one also. I am inoperable I have been told. It just means you will not go to him and get meds and then go to another dr and get the same meds at the same time ( abuse drugs) He also doesn't want you to OD because of something like this maybe. People seem leary to go to Pain Management but actually the reason to go to them is they are specialized in this field. All docs may be doing the contracts now. All doctors and or Pain Management should do all they can to use therapy and other means before leaving a patient on narcotic pain pills.
Oh the patients side of this. Doctors can prescribe pain pills and by what they have encountered with past patients they assume that you should not still be suffering. That is totally wrong. It could be that you may have two issues, referred pain like sciatica , starts in your back but sends pain down your buttocks , thigh and calf. I go numb in my left arm and to my middle finger from a cervical disk bulging. I have sciatica in both legs , and one goes numb and it varies in how I stand sit. I don't remember what REM sleep is like. The pain is so intense at night even with meds that I have to get up and move and I sway. I have osteoarthritis in my whole spine also. I had a operation and it was a success. I had to have pins , rods ( I think) and screws from L3-L5 . I didn't feel any pain after the operation and did not take another pain pill for anything for 12 years. I have only had two general practioners. I fell slipped in water at Walmart. I didnt sue. I was too depressed. It took me four years to find this doc to fix me. He told me that my success was due to my exercising and keeping my weight off. However I saw him in July and fell in August, I did a split and the fusion slammed me forward but when I could go no further it slammed me downward compressing my spine. I have 4 spurs , 3 bulging disk, Osteoartritis and because of all of the injury it has made my Scolosis much worse. I cannot lay on my back and my left shoulder touch the bed. All I want to be is fixed. I am 53. I was 38 when I had the other surgery , that was 14 days in the hospital,. cut from my ribs to my anus and a year in a body cast. I should of sued. They spilled water it was obvious from when I was laying on the floor , when the some 20 people who were so shocked I fell so hard moved, the steel cart made sense as my husband spotted a case of water and two open bottles where they had a spill while stocking but didn't see it close to the shelf and didn't cone. I had been on the pain meds as I had just gotten off of chemotherapy and then I could not get off of them. I went back to see my Neuro who had moved to Va, one of the lowest malpractice rate states. Drs that used the Pedicle %?#$$ were sued when they broke etc. It was experimental and the contract was invalid because they did not tell that they could break and in some instances it would be dangerous to take the metal etc out and you had to live that way the rest of your life. I think he was sued and that is why he left a lucrative practice in Chapel Hill , NC, to go there. I was told while chatting with patients in his office. I drove 4 hours to see him , that he no longer did or believed in surgery. I was upset because I had driven and was in much pain and I waited 3 hours in the room . As I started to go to the bathroom his nurse called me another ladies name. I said to her. I said I am so and so. Her eyes got huge and I said, did you just see, xray a tentative patient for surgery with my chart. She came in and went on and on about they make mistakes and I said, fine I just want to see the doc. She thought I was being a brat but I was about to die from pain . My doc came in and all the years 12 of him greeting me as a highly regarded paitent he didn't even look at me. When he looked at my meds and saw what I was on, he said I will not even treat you or do surgery till you are off these drugs for 3 months. He didnt even know the extent of how bad I was. He had not xrayed me. I think he used it as a scapegoat so he would not have to operate again. I was so hurt and felt so betrayed. However, doctors do judge you. People do not understand chronic and persistant pain. I did all the right thing. Walking for 2 miles in about 30 mins at 6 weeks post surgery and I not only did the exercises once but twice. He promised me 80 % freedom of pain, I had 100. But he still let me down.
Sorry, I got off track a min.
Your contract is with that doc. If you were to go to ER over and over for pain meds they might think you are seeking drugs. It is best if you have chronic pain to let him up the medication. We build up a tolerance to the meds. Because they work with the brain this is why I suppose. A lot of people suffer and they get on the wrong track, taking other pills and so forth, going to ER because their doc will not handle the pain. That is why pain management is preferable. They specialize in pain. You an go to ER for pain meds, but you have to tell them you are on those meds. Because if you are in severe pain, it could be attributed to something else. They may give you a higher dose but you should tell your pain management .To break that contract all you have to do is stop using that doctor . The contract is to protect you and his license .
I went to 4 neurosurgeons and physical therapy for 4 years and I suffered . I didn't know back then that you can become tolerant to that dosage. I meant I suffered. I went to one of the most prestigous teaching university neuro and she told me she wanted to do the injections and it is L-5 that is causig the Sciatica etc. I had to sign a paper saying I could be paralyzed and or loose bladder control. I realized later there was no way she could get those meds from L3 to L5 and I almost completely lost bladder control. I can barely do Kegels something I have done all of my life for this reason and obvious reasons. I wet myself for two weeks. I would stand and it would start leaking. I am still working on it. I will not go back to her. Why would she do that. Money for the office or just that she is . I don't know.
Doctors need to realize that most people will not have to go to ER or seek drugs if they manage their pain. It is cruel and inhumane not to also. To judge is the worst. I thank God I have an empathetic, intelligent and gifted doctor who knows that I will do any therapy and take a chance on any op to be okay again and not have to take these drugs. I do not feel any effects but I feel the scrutiny from others that do not know what I go through and how it is.., if only they would.
You take care hugs
Even in another country I am being judged that I'm just drug seeking. If you've read my posts ironically I am fighting to get back on Norco when I have been put on oxycodone. Norco is a weaker narcotic and not as strong as oxycodone, the dr here still assumed all I was wanting was the high. I've been on norco for 3 years and as many of you know 3 years later your not getting a high off of these medications. I praise God that 3 years later it still manages my pain even if I am on more now than I started out on. Doctors assume that your drug seeking, or that you shouldn't be in the kind of pain that you are in. My favorite was when I had a ruptured ovarion cyst and a Dr (male) acted like all I was doing was trying to get pain medication. I actually asked him if he had a vise squeezing his testicles would that be painful and would he actually need pain relief. He then gave me an iv injection of Demerol and some antibiotics. The Dr that diagnosed the problem was probably one of the worst. He said oh yeah you've got nerve damage, and it's going to be some pain but your just going to have to learn to live with it. I started crying saying that it was unacceptable for him to tell me that I just need to learn to live in pain and not do anything about it. He actually sent me a letter stating that he no desire to be my Dr. I still don't understand how a Dr can diagnose a problem that is going to have give you pain and not want to treat the pain. Even my husband doesn't understand, he acts like I should just walk it off, but if he is even in the slightest bit of pain is the biggest baby. I sympathize with you, and the only advice I can give you on the pain contract is just not to get pain medication from anywhere else for the same problem. If you ended up in a car accident of course they are going to treat you with pain medications and it won't be a breach of your contract.
To those who commented on the flatulance device, LMAO. Thanks for the comic relief.
To those who are/have been in my situation, I sincerely empathize for all of you, too. I think it is wrong for a Dr. to decide how much pain he/she thinks you should be in. Only you know, for each of us it is personal.
That said, wait until you hear this, talk about uncompassionate! I saw the PM dr again yesterday, and asked why one of his assistants would deceive me about the contract, not let me read it, how is this ok? He did not answer, just looked at me as if I'd grown another head. When I asked for a copy of what I signed, he said "I can give you a copy of a blank one, but I can't hand you a copy of what you signed unless you want to be here another hour, because you'll need to sign a release of information." I argued for a minute that it is MY right to get copies of everything *I* signed, *I* am not a third party, but nope. He was adamant he was NOT going to give me a copy of MY contract.
When I gently confronted him about whether or not I could go to the ER IF needed (I have only gone three x in a year, when pain got to an 8-10 for two days), he said "Of course you can go to the ER, but you are NOT to get any narcotics from them b/c it is against the law (this is also a lie, as with my other Drs it was never a problem, so long as I followed up with them asap). I assured PM dr that I didn't need ER that often, but it is a relief knowing that I have that if I need it, and him taking it away from me is cruel. He said, "It's just pain. No one ever died from pain." Let me also state that whenever I go to the ER, I bring my meds because I'm usually in too much pain to tell them. This way they can see for themselves.
I took it one step further and said "What if I have an accident and need extra help, God forbid, but what if? PM said "No, you cannot receive narcotics".....Wow, I'm thinking, just wow. I was frozen in shock, so my husband spoke for me, and this Dr was extremely rude to him as well. My husband is a PhD, too, but not in the medical field, and he calmly called this Dr out on his BS. The Dr. was getting mad, but he remained in control. Then, oh get this, I'm sitting there silently crying while husband and Dr. are talking. Dr said "Are you ok with this?" and pointed at me. Husband said "with what? My wife crying?" Dr. "yes", Husband says, "What is wrong with crying? Especially considering that you're telling her she is to live with a level 10 pain quite possibly for days." Dr. said "well, it's your life." OMG, did he really just say that? I piped up and told my husband we should just go.
On the way home my husband had a few choice words for that you-know-what of a Dr. I still feel a little shell-shocked, and quite traumatized by the whole experience.
I would advise anyone who is being sent to PM, to interview the Dr. BEFORE signing any contracts, just incase you have any questions, and don't rely on their assistants to tell the truth. If a Dr. won't see you until you've signed a contract, something isn't right.
Blessings to all
wow...thats unreal...dont know what to say...sorry to hear that









Well if the pain contract states that you must adhere to a certain set of expectations to continue getting your meds from the doctor you signed it with, and that doctor is no longer going to see you, then I would say you are free to seek out another doctor or the ER for any kind of treatment including pain relief.