Pain Doc forcing all patients onto Kadian

[hdb1982]

I went for my monthly pain management appt today. I must say the past 6 months I have been seeing this dr is the best I have felt since I got sick about 3 years ago. He came in and asked if everything was still the same and I said "yeah no new problems" He replies with "thats good, I am not going to be able to keep rx'ing Percocet. I am going to put you on Kadian" I was shocked b/c my pain was being controlled. His only reasoning was that it would better control my pain, which wasn't a complaint.I knew this was a name brand drug and would be expensive b/c I don't have insurance. I expressed this to him, I am already paying 75.00 a pop to see him. He said for a month supply it is around 130.00. Still expensive but not too bad. I pleaded with him not to do this but was told "it's this or nothing". So I took it, thankful to have anything. He gave me 14 pills, 7 days worth. It was 69.00 for 1 week supply. The pharmacy said it would be close to 300.00 for a month. When I was leaving the office there was a Kadian pharmacy rep in the lounge and tons of Kadian merchandise, clocks, staplers etc. I took my first dose and hours later was in horrible pain. I called the emergency line. I had already taken my 2 5mg percocet for breakthrough. His wife, a dr in the same practice celled me back. I went on Kadians website and found that for the dose of Percocet I was taking, 60mg, I should have been given a minimum of 90mg of Kadian. I mentioned this to her. She said none of his patients were going to recieve short acting meds anymore. The people taking lower doses will get 1 dose of Kadian a day and the people like me taking higher doses will get Kadian 2 x day. I asked why and she said "we are having problems with the short acting meds" and wouldn't go into more detail. I called the pharmacy and asked if there was a generic extended release morphine and she explained that is what MS Contin is. She saw who my dr was and said all of his patients are taking this now. I asked of there was any reason she could think of and she said "he goes through spells, we will see all of his patients get switched to one particular brand of medicine then the next month we will start seeing the brand issued coupons roll in." She said they are starting to worry if kickbacks are involved and suggested I file a complaint about the possibility of him receiving kickbacks. When I spoke to his wife I asked her what I should do and her response was to tough it out until I see him next Wednesday. I can go back to my old uro, he already said I could come back to his pain clinic anytime as I was an ideal patient but his next pain clinic isn't until Sept. 8th. What do I do until then?

[katie87]

I have no advice but i do know how hard it is to go without pain meds or pain management when you need it. I have not heard or kadian before but i hope you get things worked out, some Drs. just dont like perscribing pain meds, i have severe pain and my doctor will not perscribe anything narcotic. Maybe you could keep the appt. with the doctor who was giving the kadian and tell him it was not taking the pain away, if he wont try something different i would get another opinion.

[hdb1982]

I have called and left a message. According to the website I should have been given a minimum of 90mg and I was given 40mg. It is no wonder I am hurting and the Kadian has given me a horrid headache.

[leelee88]

Hello Heather, Maybe it would be a good idea to go back to your other Dr.. I know this does not help you now but at least you know he will not change your meds on you..

Btw what is Kadian?

[Claredale]

Heather, I am so sorry that you didn't have a reply. I was pretty much in bed yesterday. I have been off work since Monday afternoon due problems sleeping, freq/urg. I am trying to get an adjustment on my implant, but found out that the doctor's group upstairs doesn't have the computer to do the adjustments on a full-time basis. So when I went today, it was with the understanding that the computer will be back. My doctor is out of town. There was another patient of Dr. Ling's there that was in tears because she couldn't get the help she needed.

The new doctor did see me for a few minutes and went over my history. It was the first time I have ever felt like I didn't have a clue in my head what what going on. When I told him that Prosed DS had been working great for me, he wants me to take Vesicare. I explained that the OAB meds only caused me retention. He asked if I had taken Vesicare before and I said no, but I have taken, Detrol, Detrol LA and Ditropan as well as the extended version with no success. So obviously he wasn't listening to me. Especially when he said I will appreciate not going to the bathroom so often. I told him I was going 6 to 8 hours during the day without going to the bathroom when I was at work. When I was busy, my bladder issues weren't even on my mind. He finally got the point when I said 6 to 8 hours! But, I am still to take the Vesicare and possibly have surgery where they can look in my bladder again because there may be some damage that wasn't there before. Again, didn't I just tell him that my bladder was doing better than it had in a long time, especially from taking the Prosed?

He seemed to act like the surgery was going to take place and he would "talk" to my own doctor about it. I told him no, I wasn't going to have the surgery unless my doctor thought it was necessary. I don't do well with surgeries between healing and the fact that I get so sick to my stomach. I felt he treated me as if I was a wimp. I am in no way a wimp. I just know how my body works!

Sorry for the vent. I am upset as I am sure you were and still are. I hate it when things are going smoothly and wham, a small problem can happen and things are turned upside down. All that could be going on with me is stress and being over tired. I visited my mom over the weekend, so that normally stresses me because she doesn't know how to just sit down and visit. It is constant on the go things. She doesn't believe in watching TV or having conversations, so yes, I was stressed with the idea of how my weekend would be, plus I was leaving my dogs (one being blind) in a kennel which always upsets me. You would think I was leaving my 2 sons when they were preschool age! At least I could explain to them I would be back and they had friends to play with.

I know Sept 8th seems a long time away. I can't figure out why your current doctor feels the need to treat all of his patients the same way with his "spells". I will keep you in my prayers and you know you can pm me when you need to. I don't know anything about Kadian.

Kickbacks did come to my mind as well.

Sorry for the vent about myself! I will watch for any updates going on with you!

Hugs, T

[hdb1982]

Hello Heather, Maybe it would be a good idea to go back to your other Dr.. I know this does not help you now but at least you know he will not change your meds on you..

Btw what is Kadian?

KADIAN® (morphine sulfate extended-release) Capsules provide less pain with more options. KADIAN® capsules are an extended-release oral formulation of morphine sulfate indicated for the management of moderate to severe pain when a continuous, around-the-clock opioid analgesic is needed for an extended period of time. KADIAN® dosing can be tailored to each patient's needs by balancing pain relief with side effects. With several ways to take KADIAN® capsules, patients get their own precise pain relief. KADIAN® capsules can be taken once or twice a day.

I should be getting a minimum of 90mg daily compared to the dose of Percocet I was taking. I am getting 40mg. 20mg every 12 hours. It isn't touching the pain and has given me a horrid headache

[snowgirl]

Heather

Like I told you they are not going to get that dosing right on that Kadian conversion and a lot of pt's at your clinic are going to be in pain. It was the pain PA who tried top put me on kadian and I refused it!! It was a very low dose over 24 hour period I thought my darvocet would work better then that. Plus like I told you EXPENSIVE most insurances wont pay for it.

I agree with the above post. I think you should go back to old md for pain control. This guy sounds stuck on kadian. Sounds like maybe he got fined or violated and is suspended for a certain time in short acting opiates. You don't just switch your whole pain clincic to Kadian one day. THe whole clinic every patient doesnt' sound right.

My pain clinic they won't prescribe on the other hand oxycontin to ANY of their patients at all. No one gets oxycontin at my clinic per head anesthesilogist.

Vicky

Hope you have some percocet left.

[Kara Isabel]

I hope you get this resolved, I was on Kadian for awhile and it just didn't control my pain as well as the other meds I've been on. I would keep on the doctor, it sounds like you aren't the only one, so I bet more people are complaining, and he'll have to listen. Just be persistant!

Hugs,
K.

[hdb1982]

I don't know what to do. Just as my Kadian wears off and it is time for the second dose my headaches eases up. Then I take my next dose and within an hour the head is back to feeling like someone is tapping it with a sledge hammer. Noise is the worse, and I have a 5 year old so avoiding the noise is impossible. I don't know what to do. Should I keep taking it and deal with the headaches so it can build up in my system, even though it will be changed on Wednesday, or don't take it. Right now it is doing nothing for my IC/Endo pain.

He called me back yesterday, when I ran to get cigarettes, and left me a message telling me that the Kadian can take 4-5 days to get built up in my system and the headaches should subside in a few days. If by my follow up Wed. I am not getting relief but the headaches are gone he will increase the dose. If I still have the headaches he will change me to something else. I can't afford this med. It is 5.00 per pill and that is for 20mg. If he increases me to 30mg it is 8.75 a pill. If he knew it wasn't going to give me any relief for 4-5 days why was I not given more breakthrough meds. I got 2 5mg Percocet a day. When I got his message yesterday I called and asked if he could increase my breakthrough until the Kadian takes effect. He called and left another message telling me he would not increase the meds address adjusting them on Wednesday and to "tough it out".:cussing: His nurse was kind enough to tell me she understands. Maybe I was a little mean but damn it I am in pain and without sleep so I said "So you know what it feels like to have a 15 pound bowling ball made out of razor blades that has been set on fire trying to push itself through your pelvis? And have a migraine all at the same time?" She said she doesn't understand the pain I am experiencing exactly but knows how it feels to be suffering and not being able to do anything about it yourself or find a doctor to help and she is truly sorry. She said if she could write me an rx for more break though meds she would but she can't. She also can't tell me why he is doing this. She said "You have never missed an appointment or even been late, you have passed all 11 of your drug screens, never asked for an early refill and your pharmacy record is clean, the check every 6 months, so I do not know why he won't budge on this." I told her I heard he got in trouble for rx'ing to many meds without being a pain management dr and that is why he is forcing all of his patients onto these meds. She said she couldn't respond one way or another. I thought he was a PM dr but I guess he is an OB/GYN /pelvic pain specialist. Is there a limit to the amount of meds a dr who isn't a pain management dr can rx per month? I was getting 360 5mg Percocet each month. It was 180 10mg but b/c of financial reasons he switched it from 1 10mg every 4hrs to 2 5mg every 4 hours. It was over 200.00 for the 10mg rx and only 70.00 for the 5mg rx. I was getting the same mg daily just more pills.

I can't afford to pay 80.00 a week to see him plus the price of the long acting meds. In one week I will spend 230.00 just for seeing him and 1 rx. I have an appointment at a new pain clinic on Sept. 8. Do you think if I tell him I am unable to afford seeing him any longer and asked for my regular rx, just to last until my appt 09/08, he would do it. Or do you think he would get offended that I was switching drs or think it is just b/c he wouldn't give me the rx I wanted. I told him back in June I may not be able to keep seeing him b/c of the insurance running out. I don't think that is unreasonable request. Just give me what you have been giving me for 6 months for 2 more weeks. Plus I don't see the point in paying him 80 a week for the next 3 weeks and to be a guinea pig for these long acting meds when I am switching drs. The WVU pain clinic accepts WVU access, a charity care program offered through WVU. All I have to pay is a 10 co pay. I will still have to pay for my rx's but not the full price to see the dr each month.

Also the pharmacist said he doesn't know why, considering I have no insurance, he didn't just rx me MS Contin. It is the same drug but comes in generic. For 2 x day for 30 days it is only 80.00 versus the 260 for the Kadian, and that is for 20mg. If he increase it to 30mg it is over 500.00......KICKBACK is really coming to mind. He was nice enough to give me a Kadian prescription card for 50.00 each months supply, wasn't that nice. Someone tell me what to do...I know this was all over the place but the questions I need advice on are in bold and a different color. TIA~Heather

[hdb1982]

I saw my doc yesterday. My appt. got moved up a day thank God b/c my pain level had got to the stage where I was debating a trip to the ER. He came in and asked how I was doing with Kadian and I told him exactly how I had been. He said he was sorry it didn't work but we'd try Methadone now. I stopped him then and there. I explained that I don't have ins and in 1 week I spent 236.00 in 2 office visits and 2 Rx's. Being unemployed, I can't do that every week.
He gave my my original rx for Percocet with the exact amount I need to last until the 8th of Sept. Then he wished me well and we took care of some paper work.
I told him I had 2 appointments on Sept.8th. At 9am I go see Dr.Z, my old uro-- he told me I could come back to his pain clinic. He will only rx Lortab, Loracet, and Percocet x 120 per month, no more. Then at 7pm I go to my family care drs clinic to have a consult with a pain doc from that clinic. He will look over my records from my uro and my gyn and he will tell me what his treatment plan would be if he decided to take me as a patient and I decided to use him as my pain doc. After that appt. I will decide which route I want to go. Dr. Zaslau or the other doc.My uro is aware I have the consult. He said he thinks it is a good thing, that I am exploring other options to see what is available to me. I guess the new doc does a lot of research on a patient before he offers to help. I had to wait on him to get my records, run a pharmacy report on me and a drug screen also. Since I have had 12 drug test in 6 months they didn't require I come in. The results from last Wednesday's test was in the med record he received from Dr. H.
I made sure Dr.H voided my narcotic contract effective Sept. so I didn't accidentally burn any bridges there b/c of improper documentation. He had his nurse write a memo to be added to my record. "Patient will be receiving pain management through a different doctor as of Sept.8, 2008 due to financial reasons. She will no longer be held to the terms of this contract after this date. Patient is eligible for pain management treatment through my practice at any time in the future, with a written release from the other treating physician." He and I just signed it. I got a copy and it was added to my file.

All in all I am very happy, not happy I went through a week of hell, but happy with the outcome. Now if Sept 8th would just get here so I could meet the new pain doc, I'd be set.:smile tee

[justice4j]

That sounds like half of what your problem was/is!

I am glad you have options and hope the best for you soon!