Friday, August 13, 2010

Depression Rating Scales and Chronic Pain Patients

I, as a person with chronic pain, frequently get accused of being depressed, by family, friends and medical professionals. I wouldn't mind it if this were genuine concern, which sometimes it is, but in the case of medical professionals, it's generally a brush off. "You're crazy, I don't have to deal with your medical issues." It's a lot easier, and safer, for a doctor to refer me to a psychiatrist, than to prescribe me painkillers in a strength and dosage that actually works.

Consider this: five years ago, I was on (DUMDUMDUM!) 20 mg Oxycontin with Percoset for breakthrough pain. Yes, the evil, dreaded hillbilly heroin- or, as I called it, 12 hours of effective pain relief that allowed me to live my life. I took this medication exactly as prescribed. I never "lost" my medication or took too much or anything else, so I was a little surprised to be downgraded to Vicodin, with nothing else. And then be accused of being depressed. By the same doctor that had previously had no trouble prescribing me Oxycontin in the first place.

I was surprised, that is, until I saw a local doctor sent to prison for "overprescribing". Then it all made sense. The DEA wanted to make some kind of point, so I got screwed. And my doctor couldn't tell me that, so he used depression as an excuse.

What's even worse about that is that chronic pain patients will score as being depressed using depression scales. Why is that? Well, let's look at the symptoms of depression:

Feelings of: Sadness, hopeless, helpless, worthless. Well, sure, I'm sad that I'm in pain. I have no hope of it getting better, and I am helpless to do anything about it.

Feelings of guilt. Yeah, I do feel guilty about all the stuff I used to be able to do and can't keep up with anymore. It's not my fault, it's the pain, but guilt isn't entirely rational.

Insomnia. Break your leg. Now go to bed. Oh, you can't sleep? How odd.

Loss of appetite. Break your leg. Now try to eat a nice, steak dinner. What's that? You don't want to eat? That's weird.

Difficulty keeping up with work and other activities. Break your leg. What? You can't go to work? You can't mop the floor? I wonder why.

Loss of libido. Break your leg. Wanna fuck? No? Freak.

General somatic symptoms. Heaviness in limbs, back or head. Backaches,
headaches, muscle aches. Loss of energy and
fatigability. Well, yeah, that's my entire problem. Oh, it's all in my head. C'mere, I need to break your leg.

slowness of thought and speech, impaired ability to concentrate, decreased motor activity. Break your leg. Now recite the Quadratic Equation. No, that's not it, you must be depressed.

Agitation, including fidgeting, playing with hands, hair, etc., moving about, can't sit still, biting hands, nails, etc. Break your leg. Now why can't you sit still?

Hypochondriasis (and this one's especially offensive) self absorption, preoccupation with health, frequently asks for help. Break your leg. Why are you so obsessed with this leg? Why do you keep bothering me about it? Why are you so self absorbed, I have feelings, too, you know.

Now, imagine being a chronic pain patient and being asked to fill out that depression assessment. Imagine being a chronic pain patient, begging your doctor for help with the pain that is destroying your life, and having him suggest to you that your real problem is that you're depressed, not that you're in pain. Imagine being told that repeatedly by people who haven't spent 5 minutes in your body and are really just trying to get out of dealing with you.

Yeah, I'm a little bitter.

13 comments:

  1. The treatment of pain is heartbreaking. A family friend who passed away from pancreatic cancer suffered from severe neuropathy for years before his cancer. His doctors were, thankfully, pain experts and were both compassionate and knowledgeable in terms of both the pain and the depression that came with it (because, let's face it, chronic conditions ARE depressing). Some of his family, however, paranoid and ignorant, decided behind his back that his doctors were just looking to hook a forever patient on opiates, and that the pain was "all in his head" because he felt guilty over marriage and parenting mistakes in his past. It took his third wife (and now widow), an acupuncturist, to finally start to turn some of the family around.

    I have no patience for selfish know-it-alls who dismiss chronic pain and other conditions just because they can't see them, or have preconceptions about the conditions and can't be bothered to educate themselves.

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  2. Ugh. Over-prescribing doctors are awful. I had one a few years back who had me go from no medication to 4 different ones at a time because he thought I was bi polar (I'm not). Those meds completely fucked with my mind & body and I still want to kick that doctor's ass.

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  3. I'm sorry you have chronic pain, Pers. I can't imagine how that must be, and I admire your having the energy and dedication to do your cranky pants thing here. And I agree: the decision about which and how much painkillers should be purely between doctor and patient: the law has no business here.

    Anyway, thanks for doing what you do.

    bussi from sunny Vienna, zilch

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  4. the decision about which and how much painkillers should be purely between doctor and patient: the law has no business here.

    If everyone is honest and trustworthy, I agree. I know a guy who does abuse oxies. He does so with the help of his doctor. I know guys who have chronic pain, who need more pain killers but can't get it (just like PF here) because of abusers like the first guy.

    Every case should be treated individually, but instead everything gets bundled together and Doctors get scared of losing their license. It is a vicious cycle because of drug abuse.

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  5. We have a guy here at my work who's... unpleasant. Sometimes. Mostly he's pleasant enough and keeps to himself, but occasionally he gets mean: petty, vindictive, angry out of all normal proportion. For a long time I thought he was just an asshole, and did my best to avoid him.

    Nope. Turns out he was hit by a car - I think while trying to help someone else with their car. Broken hip, broken leg... Most days the limp is barely visible. Other days, it's pronounced. And those behaviors that I thought were just him? Chronic, if not constant, pain.

    My point being that it can be damned hard to tell the difference. I don't say that to excuse doctors who over- or under-prescribe. Quite the opposite: that difficulty is precisely why they need to make sure.

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  6. The trouble is, where exactly do you draw the line between "legitimate use" and "abuse"? I don't see any God- or science-given answer here: it's a continuum. And while I agree about discretion being necessary, I still say: the law has no business here. I don't see how you can draft laws against abuse that don't also take away from those who need them, and I'd rather err in the direction of personal liberty than in trying to legislate intelligent use.

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  7. Zilch, which is why I say it has to be a case by case basis with the law as it currently is. If you are saying that the law needs to change, I have nothing against that. Personally, I am all for less drug restrictions.

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  8. PF:

    in, short [all the other comments + me] it appears that this is "Choir, Preaching To"



    and yeah... the whole "oh, you're depressed, why are you depressed? you're saying you're depressed because of the pain, but couldn't it be that the depression is causing the pain?" and when i say NO - i was not depressed until i had been in lots of pain, it's always "well, you aren't a doctor, how do you KNOW?"

    I HATE MEDICAL ASSHOLES WHO DON'T CARE.

    whew! sorry. it's been one of those days, bad appointments all week... sigh..............

    i hope you find a good doctor who actually LISTENS and cares about helping you.

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  9. Last year I had a lot of facial surgery which involved bone work and my mouth wired shut for several months. This on top of chronic pain from injuries other places and arthritis in the neck.

    A younh doctor informed be, when I was really in some distress that pain was not quantifyable so it had no medical signifigance, so he wasn't going to worry about it.
    At one point they were thinking of putting me in restraints because I was so restless and wouldn't "eat" my Ensure for two days, and they asked if I'd try accupuncture.

    Why not?

    I don't know whether it was the needles and "meridians" ("sluggish blood" is bullshit, unmoving blood = bruise), the placebo effect, or just the massage that went with it, but it worked. I could actually sleep, and I cared whether I lived or died.

    Medical people seem to want pain managed to THIER satisfaction, not the patients.

    They upped my dosage of interferon a month ago, and it's sure not fun. But when I see what the guys taking chemo and radiation go through, I think I'm glad I go through this.

    Then there was the time a couple years back that they removed a tumor from my side and the local stopped working about ten minutes into a thirty minute proceedure. I felt every incision, cut with the scissors, burn with the cautery, and suture when they closed me up. I hadn't felt like that since I'd been wounded.
    You, as tax payers can know satisfaction that the VAs surgical couch is worth every penny. The bars don't bend at all, " know 'cause I tried my best.

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  10. Again, I can only count my lucky stars that I've always been healthy and never gone through anything like this.

    And Sarge: I'd just like to add another plug here for the VA. An uncle of mine, a Korean War veteran, now lives in the VA home in Yountville, CA. Every time I've visited him I've been very impressed by the dedication and friendliness of the staff there. They are civil servants in the best sense of the word: trying to make life as civil and respectful as possible for their clients. I agree: the VA is worth every penny.

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  11. I've got a new one for you. When I was in the huge car wreck that broke my ankle into multiple pieces, was then reconstructed by a surgeon and held together with a large titanium plate and a multitude of screws, I had 2 1/2 years of College education in a Law Enforcement degree. Suddenly, literally overnight, I went from all my contacts, internships, college education, and past job history over the past 6 years dovetailing nicely into a career as a police officer become worthless because... guess what? I can't run. And no, there's no way to become a cop when you can't run, trust me - I've looked at all the potential loopholes.

    I currently deliver pizza part time for my local Domino's. I do this job because it's the only work I now qualify for (entry level) that doesn't require me to stand all day (something else impossible to do). I'm struggling to save up some money so I can go to the local community college and start over as a computer science major (something I had no interest in when I could walk/run, and something for which I'd be lying if I said I had a particular passion for livelihood-wise).

    Thank the Universe I found a pain doctor who recognizes there's a fundamentally depressing element to my situation and has been more concerned with encouraging me to make the best out of my bad situation than giving me shit about how I'm not perky as a clam.

    In short: those of us with extreme chronic pain have good reason to be somewhat depressed. Using it as an excuse to kick us while we're down is borderline sadistic.

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  12. excellent information on rheumatic pain, chronic pain and these are very strong for people who suffer.

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  13. I have problems with low back pain afflicts too, is very common and the doctor indicates that I take vicodin or Hydrocodone narcotic opioid are controlled in a proper way this chronic pain, and I have learned in findrxonline that these drugs should be prescribed with prescription, and they are controlled drugs.

    ReplyDelete

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