GP messing with medication

[SimplySteveRedux]

Moved in October last year and had to transfer GPs. I take around 15 different medications each month and have seen numerous professionals over the years, and has taken close to a decade to find a medication regime that works for me.

However, my medication was summarily reviewed in November, and no changes made. Since them I have had a strong opiate removed from my repeat and I have to request it individually; same with diazepam,; same zopiclone; same anti-sickness drug. I've now been asked to attend another medicaments review.

AIBU to question what they are doing? How do I prepare to deal with - I will be in a terrible state if the above three medications are deemed unsuitable, and worried they may individually target others. I have several medical conditions, some of which are rather broad in regard to symptoms. Not sure what to do here!

Thanks for reading :)

My experience of Seroxat was in 00's - just when lawsuits were being made against GSK and the suicide cases with the drug.
I also had to really push to be prescribed the liquid.It wasn't good enough then and it still isn't.
I read that pregablin (sp) is now being prescribed for hard to treat depression/anxiety but that comes with addiction too.
I don't know what the answers are tbh. More GP training and more patient medicine reviews?

Back in the 70s my Mum was prescribed Chlordiazepoxide for the menopause (as they did then) It took her about 10 years to get off it.

www.bbc.co.uk/iplayer/episode/m000dbpf/horizon-2020-1-addicted-to-painkillers-britains-opioid-crisis things are changing in the UK.

@katkit what do you mean?

I watched that doc linked above. There's are being widespread reviews of patients who are on long term pain relief. Drs are sympathetically (it seemed) encouraging people to cut down or stop.

Sympathy doesn't come into it.

If your in chronic pain even with top doses of these strong meds the question then has to be are they effective? Is the help better then the side effects? Are they making things better or worse? This is why it is important to have regular meetings with GP. People questioning this are not denying others experiences of pain but saying the importance of having regular checks and making sure the medication is right for the individual and is not doing more harm then good.

It's actually almost funny people saying that doctors should be getting to the root cause of people's pain.
Do you not realise that people spend years attempting to get proper treatment and having a cause identified. The NHS can be awful at shrugging their shoulders and just treating symptoms.

I thought there are pain clinics within the NHS now? I have no personal experience of long term pain just MH so can't comment on painkillers prescriptions.

I take azathioprine for an auto immune condition and regularly see my consultant who in turn writes to my GP with dosing advice. I have regular blood test because of it - no problem with that. Every so often, I get the rest of my repeat prescription but don't get the Aza. I don't get told they are rejecting it until I go to collect my prescription. it does my head in. I am doing all the testing required so why suddenly refuse it, when my consultant has confirmed it. Grrrrrrr

I thought there are pain clinics within the NHS now?

Quite a few of them have closed and/or have long waiting lists and I've yet to hear of a good thing about them. Their standard MO tends to be this magical 'psychological management' of pain.

Almost all acute trusts have a pain management team. They are often oversubscribed due to demand - particularly in socially disadvantaged catchments.

Best practice is a multidisciplinary approach because pharmacological approaches do not have good outcomes long term. The relationship between pain causes and mental health is complex so the best outcomes are where there is psychotherapist and psychiatric input.

Perception of pain varies enormously from person to person with a strong link to people with pre-existing mental illness. Opiates and benzodiazepines are not an effective long term solution although they are frequently used to mask symptoms.

The results of review of outcomes from pain clinics are good with something like 87% of patients reporting a positive experience and about 45% of patient self assessing a pain reduction from severe to mild. Psychological input helps people manage chronic pain and improves outcomes.

Sometimes treatment can be counterintuitive. Laying flat and resting sciatica or a mechanical back injury feels like a good idea but the truth is moving through and using targeted exercises is better. Just like exercise and cold water swimming feel impossible for the management of mild to moderate depression but have definite curative powers.
Because you don’t swallow it doesn’t mean it isn’t treatment.

Cherry - it's all well and good telling people to move through the pain, but what happens if they're in so much pain that they need a painkiller to move?

It works hand in hand.
Cut the painkillers, persons quality of life is lowered, they can't move as much, body seizes up because they can't move and so on and so on.

There does need to be a more balanced approached, healthcare professionals need to realise that some people really do need these painkillers and, by cutting them, all they're doing is ruining quality of life and ability to move, work, contribute to society, maintain relationships and so on.

Pacing, mindfulness and psychological treatments are pretty useless. Yes people are fed up, wouldn't anyone be when living in constant, severe pain? But the feelings (and pain) aren't going to disappear with thinking happy thoughts and deep breathing.

Also, you're right that pain perception varies and those with significant mental health illness, or those with traumatic backgrounds are likely to feel pain more; but it doesn't address (or encompass really) those who're only depressed, anxious or suicidal because of their conditions/pain.

Reducing someone who suffers severe, unrelenting chronic pain to a mental illness and telling them to do some gentle exercise through it helps not one bit.

Ironically the pain clinic was the place where they put me on increasing doses of opioids. I asked to be referred as I wanted what @CherryPavlova mentioned - a multi disciplinary team to help, including psychological support. I got a consultant anaesthetist and more opioids. I didn’t bother going back after a few sessions and shortly after, ended up weaning myself off opioids. I looked for a private pain clinic and they barely seemed to exist, even in London.

Oh, yes, a variety of psychological support. Doesn't exist even for people without chronic pain but who have, say, neurological conditions like autism or ADHD. So I reckon it's thin on the ground for those suffering from chronic pain, which, statistically, is more women than men. Coincidence? I think not.

I have been referred to the pain clinic. It takes up to six months to get an appointment. You then go to a group appointment where they sign you up to six sessions of "learning to manage". If you can't/don't/won't complete this you are discharged. Even if the reason is because it is held in a place with no parking and you cannot walk the distance from the bus stop to the venue. Or you work and they only do appointments on a Tuesday.

Once you have passed the initial test to prove you actually want to see the pain management Drs and psychologists it can take months to get an appt. So by this point you've been waiting almost a year from referral, are still in pain and quite probably have had to deal with struggling to access pain relief, people dismissing your symptoms and trying to have any kind of quality of life.

My daughter is bed bound. In chronic pain. Moving her via stretcher to ambulance to get to a hospital increases her pain massively. She cannot get to a pain clinic. We asked for a home visit. Said we would pay for the cost associated with that. The consultant said if she didn't want to manage her pain by coming to groups and clinics then he couldn't help. DD used to be on a range of meds some of which helped but all of which are not controlled and no longer available to her. Eg pregabelin. The system sucks.

Btw we have found that changing GP even within practice always brings drug changes because new GP doesn't bother to read all the consultant letters from inpatient stays that explain need for specific drugs eg allergies to colours in certain meds and always try to put DD into generic. I am happy to have generic anything to cut costs but please, read the bloody file even though it is 100s of pages ( digital or otherwise)

I spent months going to the pain clinic, only to change area and GP and not have them honour the decisions made there. So I could start the whole process again if I want to ever be prescribed anything stronger than an aspirin but I'm not sure I have it in me. It feels like a pointless and relentless battle if they are only going to ignore it all if I have to move house or my GP moves practice or any other number of things that could happen. I'm sick of wasting my life fighting, and yet being in pain really sucks too. Thing is it is impossible for me to meet that kind of threshold of appointment attendance without pain relief etc. Anyway. I think the biggest issue I have is with sleep, when I've been taken off the pain medications, I've survived because of the sleep medication. When taken off the sleep medication I've survived because of the pain medications. Now with no mediation for either I'm doing my best but life is just painful and exhausting and there's is not let up. Those medications once made my life bearable and functional. Now it seems like there is no end in sight. And I'm left back with all the sleep hygiene and pacing bullshit that didn't help in the first place.

There was a pain clinic doctor on ITV This Morning. It made me feel even sorrier for people who suffer from chronic pain. It sounded a lot like how the DWP treats disabled people, if you cut them off they'll die and the problem goes away. Utterly fucking awful. Oh, yes, the sleep hygiene. LOL.

Honestly, if I found myself in chronic pain I'd probably turn to street drugs.

Sleep hygiene is one of those things that works great if you basically have normal sleep, but it gets disrupted for a while because of eg transient stress. Getting into a good sleep hygiene routine can help get back to a functional routine.

If you actually have a sleep disorder, any sort of mental health issue like severe depression, that is disrupting sleep because of processes in the brain, or you can’t sleep because of pain, etc, then it just doesn’t touch the sides. No amount of switching lights off earlier etc is going to change your sleep architecture if you are really depressed. And who can sleep through bad pain?

who can sleep through bad pain

I think there's a lack of awareness on this thread of how bad pain can be for some people. I don't know, I've been very lucky, but as I've mentioned my mum has bad pain. It's no good telling her she's addicted to drugs and to get over it, you can't treat the source in her case, they've tried operating three times, and the only way she can function is with a cocktail of painkillers. She actually manages very well and has a decent quality of life though can't do everything she wants to, but if a know-it-all GP came along and cut her medication she'd probably commit suicide.

And of course you get depressed if you have bad pain. Treat the pain, make it go away or reduce to a manageable level, and the depression goes away. It's hardly rocket science.

how bad pain can be for some people.

The problem is pain is subjective, what one person feels is 9/10 pain score another could label 4/10.

There's so little thought globally of just how badly chronic pain affects our lives, and can lead to unemployment, disintegrate friendships and shatter our lives into a million pieces - and the healthcare providers (UK, but expect it's replicated elsewhere) place pain at pretty much the bottom of their agendas.

When she was still a paed are we had a lovely palliative care doctor come from the hospital to see if she could help ( because our consultant was friends with her) and afterwards she told me that she couldn't begin to imagine what it was like living with the kind of pain my DD has without seeing an end in sight. If she was terminally ill, she would have morphine in a drip, but the rules precluded that for people not end of life. TBH my DDs life ended when she became this ill suddenly out of the blue. She has asked me to take her to dignitas in Switzerland if she is still like this in another 5 years. She has no light at the end of her tunnel