Discrimination Stigma and Abuse and Neglect

The title describes what I have faced due to experiencing ongoing pain.

I was doing physiotherapy, taking NSAIDS, working and raising a family but needed pain management. Part of the issue that I am sure contributed to my pain was a very heavy menstrual flow that slowly decreased my hemoglobin over months. This all went unrecognized. Muscles weakened quickly and fatigue was ever present.

It began with arthritis and DDD in my neck. Hypermobility caused intense spasms and inflammation in my neck and shoulders and the pain was excruciating. Disks began slipping and pressing on nerves. I was permitted Tylenol 3s however some people cannot metabolize codeine properly enough to manage pain and seeing as Tylenol 3 did nothing for my pain I assume I am one of those people. After suffering intense ongoing pain for 2 years I developed severe Raynaud's Phenomenom. I was permitted 1 tablet of Percocet a day to help with sores on toes and neck and shoulder pain. This was not enough however the doctor refused to increase. I went down hill. I developed high white counts and immature blood cells.I wanted death. I was in bed and put on disability. I believe it was the constant stress of being in pain that led to autoimmune illness.My doctor dropped me as she did not want to deal with my symptoms and I was forced to drive 50 km away to find a doctor who would treat me because everyone prescreened me by phone and would not accept me as a patient.

I found a doctor to care for me and who knew the value of adequate pain management. I was put on MS Contin but eventually needed a 50mg Fentanyl Patch as well. I was able to manage without further increases. My dose would be equal to approximately 300 MED. I had enough room to wean down when pain was better and enough room to titrate up when pain was worse. I knew that I needed to use several strategies to manage pain so that the allotted medication would continue to work. I was educated as to the benefits and risks of treatment and knew about tolerance. I knew that in order to avoid increasingly higher doses that I had to wean down whenever I could. The strategy I used allowed the meds to work and I did well for 13 years. Then I lost my doctor.

Two doctors refused to take me on because I was on opioids. I found a Nurse Practioner to take me on but she was concerned about my using a Fentanyl Patch so she wanted me to use only MS Contin. I am struggling at times now because at times the MS Contin makes my feet and legs swell and does not always work for the pain. The Fentanyl Patch took care of a lot of the pain without that side effect.

I am an adult. I am a former nurse and of sound mind. I understand the benefits and risks of opioid treatment and as such I should be able to get the medication that worked well for me. The Health Care Consent Act allows for autonomy and I am being denied the privilege of deciding my treatment.

Communication, education and trust is the key to safely treating people with chronic pain.I also believe that those who need opioid medication should be offered a low dose antidepressant to help deal with fatigue as pain can cause depression.

For those who need opioid medication for daily pain-90 MED is often too low. They need room to titrate up and wean down. Teach them the importance of protecting the dose so their medication will always work. If the dose is too low it does not allow enough room to titrate up and the patient will have pain more often than they don't. if people are aware of why it is good to avoid ever increasingly higher doses most will do what they can to avoid it and put up with pain when they can and use other measures to alleviate it even though inconvenient. Example- Much of my pain from my neck presses on my nerves and the pain runs down my arm. When I am laying down I can position myself so that I do not get the nerve pain in the shoulder and down the arm. When I am at a higher dose I will often remain in bed to decrease my opioid use. This way the medication will work when I am up and about. A dose of 90 MED does not allow much time to be up and about. I also suffer from excruciating face pain and need to account for use of pain medication to combat it.

Patients of sound mind need control over their own lives and making them go to the street for medication endangers their life and their freedom.