Pain Management Dr.

[Murph]

FF,

 

The Doc is BSing you. I hate to say this, file a complaint with the medical board (call for the forms) and fill in the facts.

 

Sam takes the cream if the crop and tosses the rest, you need a REAL LAWYER....this is against the law.....

 

Post that your still here, I will try to help ya...

 

M10

 

 

I was told by this pain doctor that you can't take opaid therapy and Medical Marijuana this is what he was basing his discussion since his license to dispense drugs fall under Federal law(DEA) and not state law even after I remind him that I was legal, but I'm not going to let this doctor off the hook he has made many mistakes in his dispensing, and billing the funny farmer is not laughing. So in closing beware but I have not found that I broke any laws here in Michigan yet. (lol) If there is a lawyer out there that is reading this please let me know but I think I'm going to call Jeffery, or Sam or Lee take care and god bless the cause

[funnyfarmer]

FF,

 

The Doc is BSing you. I hate to say this, file a complaint with the medical board (call for the forms) and fill in the facts.

 

Sam takes the cream if the crop and tosses the rest, you need a REAL LAWYER....this is against the law.....

 

Post that your still here, I will try to help ya...

 

M10

[MichaelWert75]

SMOKE UP JOHNNY

Edited May 9, 2012 by MichaelWert75

[Fat Freddy]

Lets see if I got this straight, big pharm companies pressure the government to oppress the medical mj community.

Then the government makes it difficult for the medical mj patients to get pharmaceutics ummm business as usual.

" johnny' you can not have your pudding if you don't eat your meat!

 

Hey teacher leave those kids alone !!!!

[Dr. Bob]

Pain management is a particular interest of mine. I got in to medical marijuana in response to opioid abuse in N. Michigan. I was weaning folks off absurd amounts of narcotics, and found they broke in to two groups- a group that wouldn't wean, and one that would. The one that would had a good number of folks using marijuana compared to the one that wouldn't.

 

Couple of rules of thumb (manage narcs the Dr. Bob way)

 

You are on suboxone to get off suboxone. It is not long term replacement therapy like methadone, it is used to wean you off narcotics. To zero. In 3-6 months.

 

Most of pain control should be with long acting narcotics if narcotics are used.

 

'As Needed' means just that, as needed. NOT as often as you can take it day in and day out. A vicodin every 4 hours for pain AS NEEDED means you maybe use 20-30 a month for 'breakthrough pain' not 240 on top of oxy.

 

Weaning off narcotics is done about 25% a month. 120 a month down to 90 a month is reasonable.

 

There is a difference between functional and pain free.

 

Uncontrolled narcotic use, unrealistic expectations for what narcotics can do, and increasing tolerance soon results in not being able to take enough narcotics to be effective.

 

Pain is controlled by reasonable expectations and a multipronged attack- narcotics, nsaid, exercise, antidepressants, and yes, marijuana are all useful tools.

 

Dr. Bob

[HEMP4LIFE]

a dab will do

the proof's in the pudding

and mums the word

[HEMP4LIFE]

Pain management is a particular interest of mine. I got in to medical marijuana in response to opioid abuse in N. Michigan. I was weaning folks off absurd amounts of narcotics, and found they broke in to two groups- a group that wouldn't wean, and one that would. The one that would had a good number of folks using marijuana compared to the one that wouldn't.

 

Couple of rules of thumb (manage narcs the Dr. Bob way)

 

You are on suboxone to get off suboxone. It is not long term replacement therapy like methadone, it is used to wean you off narcotics. To zero. In 3-6 months.

 

Most of pain control should be with long acting narcotics if narcotics are used.

 

'As Needed' means just that, as needed. NOT as often as you can take it day in and day out. A vicodin every 4 hours for pain AS NEEDED means you maybe use 20-30 a month for 'breakthrough pain' not 240 on top of oxy.

 

Weaning off narcotics is done about 25% a month. 120 a month down to 90 a month is reasonable.

 

There is a difference between functional and pain free.

 

Uncontrolled narcotic use, unrealistic expectations for what narcotics can do, and increasing tolerance soon results in not being able to take enough narcotics to be effective.

 

Pain is controlled by reasonable expectations and a multipronged attack- narcotics, nsaid, exercise, antidepressants, and yes, marijuana are all useful tools.

 

Dr. Bob

mmj =antidepressant x exercise / less narcotic lets see sounds like it makes for improved life and health

just a toxicology report on that study would be note worthy

Edited May 9, 2012 by HEMP4LIFE

[Dr. Bob]

I'd love to do a study on the reduction of narcotic use with marijuana. On most of my renewals that were on narcotics to start with last year, 50% reductions are not that uncommon. As I've said before, primary care doctors want to see results, and don't like to use long term narcotics. If patients getting their cards also work to reduce the use of narcotics (and the narcotics they ASK for), more and more primary care docs will start to take notice of the pain effects of MMJ and become more comfortable with it. They want something to use with patients that are not getting good results from narcotics and/or are getting to monthly doses that are making them uncomfortable to write.

 

The key is to convince doctors and the non-mmj community that this medication solves a problem, not only for us, but for them....

 

Does that make sense?

 

Dr. Bob

[cristinew]

methadone, is the worst, do not ever use this crap.. it takes forever to detox from

[Darkmatter]

I'd love to do a study on the reduction of narcotic use with marijuana. On most of my renewals that were on narcotics to start with last year, 50% reductions are not that uncommon. As I've said before, primary care doctors want to see results, and don't like to use long term narcotics. If patients getting their cards also work to reduce the use of narcotics (and the narcotics they ASK for), more and more primary care docs will start to take notice of the pain effects of MMJ and become more comfortable with it. They want something to use with patients that are not getting good results from narcotics and/or are getting to monthly doses that are making them uncomfortable to write.

 

The key is to convince doctors and the non-mmj community that this medication solves a problem, not only for us, but for them....

 

Does that make sense?

 

Dr. Bob

 

Makes perfect sense to me bob. I have reduced my intake of Vicodin by about 95% personally.

[Dr. Bob]

And what was the response of your doctor to that 95% reduction?

 

Dr. Bob

 

PS Methadone is excellent as a long acting narcotic for baseline pain control. No active metabolites, cheap as dirt. Monitor and use properly and keep the dose low. Imagine a valley that is flooded when you dam the river. The water rises and creates a smooth surface that covers most of the features of the valley. That is what long acting narcotics do. Don't flood the whole valley (pain free), leave some tree tops and rocks sticking up (functional). A short acting narcotic like vicodin can be used to 'jump' over the tree tops and rocks when you come to them. Combine methadone with a non-steroidal like voltaren or naprosyn and the dose of methadone needed to cover 'most' of the valley is reduced as the non-narcotic potentiates the affect of the narcotic.

[cristinew]

PS Methadone is excellent as a long acting narcotic for baseline pain control. No active metabolites, cheap as dirt

 

your tight cheap as dirt, do not let any patient use this stuff, it is horrible to come off of,,

[Sledge]

Methadone, you'd be better off taking a bullet!

[cristinew]

long term methadone use is bad news, http://www.drugs.com/forum/need-talk/methadone-withdrawal-29778.html

[Dr. Bob]

Personally I prefer it over Oxycontin, and we all have our preferences. Appreciate your input though.

 

Dr. Bob

[cristinew]

Yes this is from a patient that has used methadone ..it works but it is worse than heroin to get off from , long term methadone use is not a good idea, and be very careful when you detox ,, i had to use morphine to get off methadone now i am on neither just RSO

[Sledge]

Personally I prefer it over Oxycontin, and we all have our preferences. Appreciate your input though.

 

Dr. Bob

 

Have you personally tried either long term? ,

Well I have and you happen to be wrong about methadone.

[cristinew]

very wrong, just if you do give a person that garbage make sure you are there when they detox , and detox them the right way,

 

http://www.methadoneaddiction.com/

[MichaelWert75]

?

Edited May 9, 2012 by MichaelWert75

[Croppled1]

I'd love to do a study on the reduction of narcotic use with marijuana. On most of my renewals that were on narcotics to start with last year, 50% reductions are not that uncommon. As I've said before, primary care doctors want to see results, and don't like to use long term narcotics. If patients getting their cards also work to reduce the use of narcotics (and the narcotics they ASK for), more and more primary care docs will start to take notice of the pain effects of MMJ and become more comfortable with it. They want something to use with patients that are not getting good results from narcotics and/or are getting to monthly doses that are making them uncomfortable to write.

 

The key is to convince doctors and the non-mmj community that this medication solves a problem, not only for us, but for them....

 

Does that make sense?

 

Dr. Bob

 

No it doesn't make sense Bob patients do not owe the medical system anything to justify using cannabis as medicine other then they find physical comfort , increase function and have a general sense of well being .The evidence of that exists for over 5000 years .

 

I find your preoccupation well meaning but divisive of patients who require palliative care and you are putting the cart before the horse creating your own conclusions and pushing patients to fit them .

 

 

On long acting opiates they are one of the biggest scams on patients that has occured in the past 40 years none of the delivery systems are accurate in terms of when to next dose across patient populations people are either overdosing or in withdrawls crying waiting for that next pill , or patch .

 

On methadone the best source of info in the state for severe chronic pain patients comes out of the Cass Corridor from a group of maintence patients who publish a newsletter who recommend breaking up doses so their taken every 4-6 hours which most Doctors fight against .Methadone is so dangerous in terms of respitory issues which many have also in withdrawls off any opiates thus they won't wean if Doctors can't reaassure them and respond . They never go back a second time to detox and fail at about a 87% rate . Patients won't wean because Doctors don't step them down slow enough , respond to their distress and they have been hurt before and are scared . When I say hurt I mean seizures , difficulty breathing , suicidel anxiety in some cases for weeks or months . Blood tests are required to track deficiencies of vitamens and hormones needed also to be stable before ever weaning . Everyone needs their own pace and dosing on or off medication . One size fits all medicine has been the abject failure of the past 100 years . .

 

I could talk to you for hours because this interets me also as a severe chronic pain patient treated under palliative care for the past two decades but you often scare me with your statements like nobody needs more then 1 oz of cannabis a week ( people get jailed over limits and some do need more I know that ) or everyone should be able to reduce thier other medication ( pain killers ) through adjunctive use or it should be either or not both .

 

Now this said I think we both want what is best for patients and agree opiate use is a last resort and dependency of over 6 months something that never should be entered into if their is any other alternative it is like loosing your childhood you can't go back . I have found substutute medications for natural opiates have worse withdrawls then natural based ones .

 

Every person has to search their own concience about when to treat pain so agressive and deal with the terrible lifelong consequences along with benefits which are never explained to them upfront nor are detox protocals agreed to that are so important . Michigan has a terrible actually a non existant detoxificaiton network , out patient suboxone is not working for many , methadone is very hard to access and should be inpatient for weeks to months .

 

We really do need a State subsidized inpatient facility for patients to adjust and or wean off medications noteabley opiates in this State since the mental health hospitals have mostely been closed . Something like Gould Farm with special design including cool rooms with fresh air ect would be unique but people who are patients especially pain patients can't do agressive physical rehab at the same time or work like the State always desires to force which collapses many . Comfort has to be the number one priority at all times for suffering severe pain patients . Otherwise you get people who go from patients to illegal abusers to avoid suffering and even die . I personally believe we treat our street adicts horrendously also when we should be helping them ( not rewarding them ) , and they others greatful for the second chance later . They don't belong in prisons if no other crimes were committed . .

 

Have a great day .

 

If the Government wants more people to try what your saying and it is something worth tracking voluntarily without labeling those who are unsuccessful and allowing everyone their own pace and step down levels with step up rests if needed plus whatever amounts of cannabis ..... they need to stop the fear for patients who grow and allow realistic storagee limits for a non interupted supply in terms of pounds with oils and medables .

 

 

[Dr. Bob]

This is a great post and I'll review it and comment in a bit. You missed many of the points I was making and took others out of context, but I'll give a detailed answer in a bit. One of the biggest points you missed though is that I don't like folks on large quantities of short acting narcotics over time. That is a sure way to addiction. I also strong disagree with the habit of dropping people cold turkey because they got a card, 25% per month weans are far better.

 

I also don't understand your statement about the 1 oz per week. I've never made that statement. In my paperwork I give a maximum recommendation of 1 oz a week as a general rule of thumb as it handles the vast majority of patients and gives wiggle room for those like you that may need more because they use oil, etc. But it also gives me a firm basis in court when someone is caught with 3 oz to say, in reality, that is not all that unreasonable an amount and have it documented. There is no dosing with MMJ, only guidelines and suggestions. Basically you took it out of context.

 

As for the weaning through the use of MMJ as adjunctive care, and I've said this before, this is part of the care and feeding of a primary care doc who knows nothing more than what he/she was taught in med school. We were all taught MMJ was a political football by drug users looking to justify their habits. It had NO effect on pain. The key to my conversion to recommending MMJ was that it made it easier for folks to wean, therefore had an effect on pain. It convinced me what I was taught was wrong. I encourage all patients, if possible, to re-educate their docs the same way. The logic is, if you pain is stable and you take one med for it, adding a second pain med should increase the control of the pain and/or reduce the need for the first medication. Reducing the need for the first med clearly demonstrates a pain effect of the second. If the second med is marijuana, that will go a long way to retraining doctors to look at it as a pain medicine, not a drug of abuse.

 

As for being decisive, looking at an acedemic discussion as a personal attack on your value system is far more decisive than just reviewing the concept and commenting on it. You seem to have done the first, but also added in the second, which is helpful to me to get an idea of how patients in general think of the subject.

 

Dr. Bob

[purklize]

Everyone knows it's undesireable to be on opiates. But it is my firm belief that pain is woefully undertreated in this country because addicts are faking it and doctors feel obligated to play detective. It's pointless to restrict access in this way as addicts will just switch to heroin or hit up a methadone clinic when they get cut off. I've been in excruciating pain in the past and had it go nearly untreated for months or years because I am young and my issues are invisible (migraines, post herpetic neuralgia). It's very frustrating to hear people say that everyone needs to get off this stuff when I've tried everything imaginable - over a dozen medications, countless supplements and lifestyle/diet changes - nothing was helpful aside from opiates. It leads to needless suffering and makes young people feel like criminals and unable to speak freely with their doctor, instead having to play games and dance around the subject carefully to avoid saying something that throws up a "red flag" like when I made the grave mistake of begging for pain medication because my headaches were so bad I was slamming my head in doors and throwing up and I'd been seeing doctors every week about it for almost a year having tried 16 medications to no avail... I really paid the price for my honesty. I got nothing and the doctor walked out the door. They talked to me like I was being impatient, that I should just keep waiting a month for each new ineffective treatment to be tried - they didn't understand that a month is a VERY long time when you are in severe pain.

Edited May 12, 2012 by purklize

[Croppled1]

There are so many severe pain patients here I hope we can all learn from each other . Many of us are so isolated and with our treatments so suspect under criminality we were driven underground even before cannabis was legal . With Michigan practicing behavioral medcine were all so at risk for being forced to comply with taking terrible psychiatric or off label medications . The average persojn has no idea how tough pain patients have it in society . It was nice to read your reply Doctor Bob . It is so easy to jump to the wrong conclusions because of how we have been treated in the past or are personal situations of suffering causing psychological changes in perception , mood , and critial thinking . Have a great weekend .and it was nice to read your post Purklize we can learn so much from eachother pain paitents before cannabis brought us together were so isolated and unwilling to reach out to eachother . Who wants to when their in pain suffering more then they can take . But we need to just as we need good relations with Law Enforcement this treatment of patients by our AG is wrong we need his Christian empathy and support . Tough love should never apply to patients and it has been a excuse to abuse and neglect people from what I have seen .

Edited May 13, 2012 by Croppled1

[HEMP4LIFE]

Everyone knows it's undesireable to be on opiates. But it is my firm belief that pain is woefully undertreated in this country because addicts are faking it and doctors feel obligated to play detective. It's pointless to restrict access in this way as addicts will just switch to heroin or hit up a methadone clinic when they get cut off. I've been in excruciating pain in the past and had it go nearly untreated for months or years because I am young and my issues are invisible (migraines, post herpetic neuralgia). It's very frustrating to hear people say that everyone needs to get off this stuff when I've tried everything imaginable - over a dozen medications, countless supplements and lifestyle/diet changes - nothing was helpful aside from opiates. It leads to needless suffering and makes young people feel like criminals and unable to speak freely with their doctor, instead having to play games and dance around the subject carefully to avoid saying something that throws up a "red flag" like when I made the grave mistake of begging for pain medication because my headaches were so bad I was slamming my head in doors and throwing up and I'd been seeing doctors every week about it for almost a year having tried 16 medications to no avail... I really paid the price for my honesty. I got nothing and the doctor walked out the door. They talked to me like I was being impatient, that I should just keep waiting a month for each new ineffective treatment to be tried - they didn't understand that a month is a VERY long time when you are in severe pain.

 

PUKERLIZED,

we would have never known, the concept of modern medacine is just for the weary, with not being able to communicate with your doctor on a medical basis is frustrating to say the least. They talk about bonified relationship, excuse me but how in tne hell would anybody expect you to have even a chance to heal without the blessing of your treating physician. maybe this is where the caregiver comes into play. As i have said in other posts healing starts within, mind body spirit and soul.

now i know you have these elements because you helped me a few weeks ago. now thats powerful just in a few wordS you helped me when nobody else could. so if its mm that it takes a to get he job done then SO BE IT. my hats off to ya keep up the good work stay medicated , the proof's in the pudding , a dab will do , and mums the word

your friend HEMP4LIFE

[Dr. Bob]

Most folks look at methadone just in the context of heroin replacement therapy. That is unfortunate.

 

I've answered this question here and I think I answered it well. Any further questions probably should come to me as a PM rather than take up more time here.

 

Dr. Bob