To want to take this further?

[esk1mo]

Hi all, long time lurker but have never posted (although have often thought about it). Bit of a back story here...

DP herniated a disc (L4/L5) in his spine in May 2013. He was given painkillers and told he wouldn't need an MRI unless the pain persisted for months. He was on tramadol, codeine phosphate, nefopam and gabapentin. He never went over the allocated dosage and always requested new medication when he had fully ran out (ie. not going back asking for more after 4 days as if he were addicted). Despite being in agony daily (he cried from the pain frequently) he wasn't given an MRI until October 2013.

May 2014 he underwent operation for this herniated disc. He enjoyed around 6 months pain free before it started to creep back in. Although sore, it wasn't unbearable. It become gradually worse and over the last 8 months his pain has been worse than ever before. He attended his GP to ask for medication (that he was taking in 2012) but was told she couldn't give him anything until he was given an MRI although she did sign him off work. He was given an MRI in December which showed multiple herniated discs (all at lumbar level) and that his previous L4/L5 herniated had now ruptured and spread bilaterally, affecting both sides of his body (pain down both legs, hips, glutes and ribs). He can barely walk without breaking a sweat and wincing in pain. After receiving these results the GP agreed it was very severe and referred him to a surgeon and gave him a prescription of codeine phosphate. He thanked her and assumed that while he was waiting to see his surgeon he would continue to take this medication.

This was not the case. Today he returned to see GP to request more codeine (he was given 60 pills 3 weeks ago, you can take up to 6 per day). He was denied this. The GP who saw him FELT his back muscles and said he should take an anti-inflammatory. DP said he couldnt as he they made him throw up (despite taking omeprazole too). GP told DP that there wasn't anything else he could do and he wasn't allowed to give out opiate based medication. DP told reception this and asked if he could see another GP. Reception told DP that the GP he saw is indeed allowed to prescribe pain killers, he just didn't feel necessary. DP was told to phone NHS 24 if he felt his pain was so severe.

I am fuming. Not only has he taken multiple painkillers responsibly for over a year, this was when his condition wasn't as bad as it is now. He is at the stage now where he cries because of the pain. He has wet the bed on more than one occasion because he has crowding of the cauda equina nerves (which I believe are linked to bladder and bowel?). He is still signed off work and waiting to see surgeon on the 2nd of Feb.

I want to take this further but unsure who to contact, AIBU to want to complain to someone about this? I have asked to speak to practice manager but was told he was not in until Monday and when I mentioned my DP's name they said 'in that case he has already been told what to do".

I don't want to believe it is a race issue but my DP is mixed race (half Scottish half Caribbean) and for comfort he will wear jogging bottoms some days instead of a suit or jeans to see doctor. He asked a GP previously if this was an issue and she said 'it doesn't help.' I don't believe that any form of appearance should be taken into consideration when helping a patient. I have never been in a situation like this before and I am not one to complain about things but this feels so unjust and I feel there must be someone I can write to about this? My MSP or the GMC? I must mention, I am a white female and currently on a repeat prescription from the same GP surgery for an opiate-based painkiller for a hip condition, which although will require surgery at some point, is not as serious as my DP's condition. They have no issue giving me a repeat prescription for this. AIBU?

Thank you all
Sorry for the length

And if his lumbar spine is that bad, no physio will want to be doing anything with him. Warm gentle muscle relaxing massages maybe but no exercises at all

I know someone with sickle cell anaemia (affects the Black community more than anyone) and being refused pain relief is absolutely a race issue. He encounters it all the time, he's been turned away from medical centres and the ER during crises because medical professionals think he's an addict looking for strong prescription painkillers.

It doesn't help that when someone is in a lot of pain they don't "present" well, so aren't able to advocate for themselves.

Sorry OP, I hope your DH gets the help he needs.

That is awful and people saying its not a race issue havent read the whole thread with the gps comments about street value.
Ive been on tramadol, diclafenic and another opiate i cant remember (thatll be all the drugs) since nov after hurting my back after falling down some stairs.
Cocodamol isnt going to do much. Is there a walk in you could go to ?

Like others have said, back pain isn't always taken seriously. I had awful sciatica for over 2 years, I could barely walk more than a few metres without significant pain and put on loads of weight. I was in agony and lucky to get an hours sleep some nights.
Doctors would prescribe nothing until they finally did an mri and found a severely bulging disc. This took over 2 years of repeat visits.

Over the last couple of years some/ most GPs have got very funny about prescribing Tramadol even where it is a long term chronic condition which is highly documented. I am the opposite of every stereotype for drug dealing (middle aged, middle class, white, harassed mum who wouldn't know where to start drug dealing - never mind have the time or energy) but have had new GPs pointedly question my prescription as though I am up to nefarious purposes. They only give up when they find a consultants letter for the prescription. It also state it's Tramadol or a horrendously expensive drug which focuses their minds. It's not right but you just need to keep going. I would consider moving practice but your current GP may inform the new practice you are touting for drugs. When you see the consultant next week make sure he writes to the GP setting out adequate pain relief. If he can't think of anything to help, I second seeing a pain management clinic. Hope you get something resolved.

Your poor DH. From what you've said I agree race could be a factor - I had a back injury some years ago and was on tramadol for nearly a year with no questions raised about use or street value. When the pain was really bad I turned up frequently looking like a fright and never had an issue - I'm white.

Once when I'd miscalculated I was able to get tramadol from the OOH GP based in the hospital, could this be an option for your DH as the doctors will be different?

Also, might be worth paying for a copy of your DH's notes if you suspect that the GP has added something about prescribing him painkillers.

Get him to ask for a referral to a pain clinic, they specialise in pain management and will be able to help him.

Cauda equina is serious. My husband had back surgery here in n.i only when he presented with weight loss inability to get out of bed and cauda equina did they suddenly think shit this is an emergency . He was seen by surgeon and in surgery the Monday of the next week. His gp was utterly utterly shite and as we weren't married at the time there was nothing I could do. So my advice get on it asap don't let it go you are talking permenant nerve damage here. My husband has tremors and pain to this day and yes it can affect sex life.

That's a fucking disgrace, your poor DH.

The GPs conduct is indefensible. My oh has had prolapsed discs for about 10 years, and been taking tramadol regularly since then. That keeps his pain to a constant 4/10. Without it he'd be climbing the walls. Ibuprofen etc doesn't touch it and I'm sure would do nothing for your DH either.

Cauda equina is v serious and v distressing because of the incontinence issues that can result. Am so sorry your Dh has received such negligent treatment. Is there another GP he can see? Could you transfer to another practice?

There are very few areas of life where race, class (dis)ability and sex don't make a difference to how you are viewed and treated- and medicine is not one of them! Not that you'll be able to prove anything.

Does the surgeon know about the incontinence? Because usually that would be treated as an emergency if it caused by pressure on the cauda equina.
Your poor husband , as someone else suggested it is worth while trying OOH Gp this weekend to ask for stronger analgesia .
Then I think on Monday you need to speak to the practice manager . Is there another GP you can see in the practice instead of the ones you've seen already ?

Loss of bladder or bowel function is very serious and should be seen asap, as you mentioned cauda equina I assume he has been warned of this? When my colleagues have seen patients who report these symptoms they have advised ambulance direct to the closest specialist hospital (colleagues mentioned are clinical- I am not)

Hi op

Your husband needs greater gp care, perhaps arrange another appointment with a different gp and attend with him

It's possible that the gp actually has his best interests at heart but failed to explain that there is a direct link between cauda eqina exacerbation and codeine

Really he needs referral to the pain service, amitriptyline and gabapentin are both drugs that could be added to his pain relief regime, would he consider volterol suppositories if he can't cope gastrically

Tens is not pseudo science, it works on the gate theory, I've used it very successfully on an L4/5s1 injury for years, you can buy from most pharmacies

ollyBjolly thank you.

patchouli its just so odd that my codeine for a lesser condition is a repeat prescription but he is being refused anything.

we have been on the phone to NHS 24 who have organised an appointment at the nearest hospital for 10:50pm. hopefully they will help, but the advisors on the phone seemed confused that we were phoning about an ongoing condition and not a sudden injury or accident. hopefully they dont turn round and tell him to see a GP

sorry just realised there was a 2nd page of replies! thank you everyone!

some of his MRI report about cauda equina:

"Previous L4/L6 laminotomy and discetomy. There is a large broad posterior disc extrusion, causing marked bilateral L5 root compression, against midly hypertrophic facet joints, and with crowding of the cauda equina roots."

Like I said before he has wet the bed while sleeping, has poor bladder control ie. cant make it to the loo on time. I have just find out it has also affected his bowels in that it makes him feel he hasn't finished going to the loo (but he has), or makes him go to the loo but nothing happens, which is unusual for him. I will make sure he mentions this to the consultant next week.

As pp have mentioned, even gabapentin or amytriptyline would be helpful but they have offered him nothing. OTC cocodamol is really unacceptable. We have an appointment at 10:50pm tonight, I'm really hoping they take him seriously. I will bring along his MRI. On Monday he plans to ask for the GMC number of the GPs he has seen and I have bookmarked the pages that you all have suggested will help.

*sorry meant to say L4/L5

I agree with other posts that a pain management clinic might help. In pain, I would wear jogging bottoms so dont think tjis had anything to do with the issue. Your poor husband deserves all love and help. Good luck..

I really sympathise. Your poor DP.

Back treatment not good in the UK. My mother in excruciating pain - v little to be done, (collapsed vertebrae).

Poor DP - some useful advice here - keep pushing for help

Re the street value comment - the same was said to me when I collected Fentanyl patches for my 80 year old mother. Not a race issue - just a reason why they couldn't supply more than 2 weeks worth or why I had to collect them personally.

I had cauda equine, I was a nurse, I knew it was serious but was fibbed off continually by my GP.
I paid for an MRI myself and went to A&E, I was operated on in London within six hours.

I agree with the posters who are saying to kick up a fuss, those symptoms could be serious.

The street value has been said to me a few times, I think it's a standard joke/comment.

Lots of typos, readable still hopefully

And I had Cauda equina twice with three surgeries, he hopefully will get another MRI

I suggest he changes doctors. My husband has a similar problem and is prescribed dihydrocodeine (please excuse spelling, I have no idea) indefinitely. His doctor said many are on it for the rest of their lives. He doesn't have to live like that

Please mention today to the GP you are seeing about poor bowel and bladder control. It could be very serious and if there is nerve compression causing this it could become permanent.

The GP seems to have treated you badly and there is no excuse for leaving you without pain relief. I would suggest raising a complaint to that effect.

Wishing him a speedy recovery as much as you can with a back complaint.

Oh and by the way I have been refused codeine in several pharmacies as they have remarked that I am a heavy user. They will only sell me Solpadeine Max now with w prescription.

Obvs I just buy my Solpadeine when I am somewhere I am not known. I am not an addict but I suffer a lot of pain. (I am white and middle-aged)

It isn't necessarily a race issue. Plenty of people are denied painkillers. They are expensive, overused and addictive so a lot of places are clamping down.