Chronic Migraine and Pain Management

Speaking as a caregiver for someone who has suffered about 10 years living with chronic migraine, I have seen actions, or more to the point, inaction from more doctors than I care to count. It makes me question the oath doctors take when they begin their careers. There seems to be a philosophy that since there is no clear cut diagnosis or specific set of medically testable or provable things that cause some individual’s migraines, then either the patients are making it all up, or that it simply cannot be as bad as they would lead the doctors to believe. This thinking leads to problems for the patient.

Not all doctors view pain management the same way

It would be naïve to say that all doctors view things this way. Unfortunately, it seems they are growing in numbers. I personally know several chronic migraine patients with doctors that freely prescribe them with enough oxycontin to take as many as 4 or 5 per day. I am not saying this is the right way to handle things or that it is the wrong way. As a result, there are a growing number of doctors that simply refuse to prescribe any real pain medication for fear of being monitored (doctor’s words, not mine).

Are there people who abuse these medications? Absolutely! Does that mean that every patient that asks for some type of strong pain medication is a drug seeker? No! My wife had an ongoing prescription for Toradol injections for years. Then the manufacturer had manufacturing problems for a while and that medicine became scarce. Now the manufacturer is back up and running just fine, but the doctors are no longer willing to write prescriptions for it. Why is that, do you suppose? Toradol, in a simple non-medical definition is a liquid form of Ibuprofen, inasmuch as how it works. Same concept. Toradol is an anti-inflammatory medication that functions like Motrin, but functions more efficiently. It isn’t a medication a patient can get high with. It simply helps to break the cycle of a migraine. Its also used as an immediate pain medication for patients dealing with kidney stones.

The catch 22 of pain management

Neurologists here in Texas all seem to be one trick ponies. One will only use Botox. One will do no treatment other than trigger point injections, (which by the way is simply a fancy name for a nerve block). Insurance companies don’t like to cover nerve blocking treatments, so doctors found a way to beat the system by calling it something else so that it can be covered. Other doctors will only work by surgically implanting electrical wires subcutaneously on the skull. Otherwise known as a STEM. The one thing all of these different doctors have in common is that, once they are satisfied that their “one trick” did not work, they want to refer you to a ‘Pain Management” clinic.

I have taken my wife now to three different pain management clinics in the last 5 years. The one thing each of them had in common was that, not one of them prescribed medication for pain. They are also one trick ponies. Their trick is to throw anti-depressants at the patient, because some idiot somewhere along the way decided that was a useful treatment for incapacitating pain.

Caregiver’s frustrations

My frustration lies in the doctors themselves. I am a combat veteran. I understand all too well that I may have a way of viewing things that differs considerably from the way doctors view things. In my eyes, a doctor who is uncomfortable or unwilling to prescribe a medication simply because it may be a medication that is highly monitored, is a coward. I have had this exact conversation with my own doctor. While I try to remain as respectful as possible in doing so, I have told her on more than one occasion that if she is afraid to do her job, then perhaps she is in the wrong line of work. When she tries to throw the government monitoring back as an argument to defend her position, I pose a simple question to her. If you are a doctor licensed to practice medicine in this state and are writing the correct prescription for the correct symptom; why does it matter who is watching?

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