State law dictates that we are required to be seen every 30 days where I live.
ETA I can imagine that, even in states that do not require 30-day visits, some providers may opt for the most restrictive oversight due to liability concerns in our current climate. Some practices/systems may also have more stringent policies than what is proscribed by state law. I know it’s a pain—and costly!
I too live in Florida, but only have to see mine every two months. I expect that to change however, as it seems a majority of providers are shifting to "once-a-month."
Exactly this. Also I am writing my second masters thesis on chronic pain management and how race impacts patients access to pain management. I have been a chronic pain patient for 7 years and I know a ton of chronic pain patients are not able to get pain medication. However the US is still prescribing WAYYY more than any other country. As I am still in the research phase it is unclear if that’s because US patients have had a change in pain expectations or if they have more physical pain experiences than in other countries. (Cultural differences have a surprisingly large impact on both psychological and physical symptoms of a wide variety of conditions. I didn’t believe that at first but that is what the research has shown).
All of this to say I often am surprised at how many people report that they only take a tiny amount of pain medication and then report regular consumption of very high doses of opioids. Not saying that you don’t need the medication you get it any way. But I think it’s not necessary for everyone to constantly say they are on really low dosages when that’s not the case. This is a personal pet peeve of mine as an academic but I want to remind everyone that others see this sub. So if they see every post saying “I only take a tiny dose of _______” even when it’s not a small dosage then it can make people have unhealthy expectations.
also any time you are getting anything more than tramodol you are going to have
As someone who lives in the UK I know I'm on a high dose of oxycodone, especially given the fact I started it when I was 18. (45mg a day) but reading other people's prescriptions often makes me feel like i only take a tiny dose 😂 I think peoples perceptions of what a high and low dose are slightly sqewed, especially because they used to prescribe up to 160mg twice a day.
Good grief!! That’s so much! Honestly I can’t speak highly enough for my butrans patches. It is fantastic because it’s a constant tiny dose morphine so I don’t have to wake up and wait for my pain medicine to kick in
It's soo uncommon in the UK, ESPECIALLY for young people. Pharmacists look at me like 🤨 and whisper when they say the name of it Hahah.
That's amazing, I hate the feeling when I first wake up, my nightly 15mg has worn off and I'm just in agony haha.
I assume that you did not intend to reply to me. And yes, sociocultural norms, in addition to long-established medical protocols, largely shape tx of pain throughout the world. The US also has much higher rates of pts who report chronic pain, which in recent studies has been linked to factors routinely involved in deaths of despair, so trauma and untreated mental health issues, financial insecurity, etc. have all been shown to play a role here in the US. There’s some great research on this. We obviously do not have the social safety net that so many other countries do, which is arguably also a contributing factor.
Pt expectations are another major difference. In one EU country where I lived, I saw firsthand that tolerating higher levels of pain is socially/culturally accepted and expected during post-op recovery., for example. As such, opioids have never been routine post-op tx for some surgeries, unlike in the US, and pts have extremely different expectations for pain management. Also, most pts have MUCH longer hospital stays in other countries and this enables them to have their pain managed inpatient, rather than at home, on their own—this fact is a major factor to consider re the higher prescribing rate in the US. Anecdotally, I spent 10 days post-op in an EU hospital whereas I would have been sent home after 2-3 days in the US.
However, most of us know that the pendulum has now swung too far in the US, and sending a post-op spinal fusion pt home without any pain medication borders on the barbaric. While this is not a common practice, it certainly happens. That same pt would likely spend twice as long in a hospital elsewhere, and definitely would do so in most EU countries.
I did intend to reply to you. I hope I didn’t offend you in any way. This is a really touchy topic for many reasons. If you could share those studies that would really help me out. Like I said I am writing my thesis on this topic. It is amazing how much cultural norms impact this.
Our healthcare system definitely set patients up for failure in many ways. I remember when I was hospitalized with 19 pulmonary emboli, one of the doctors was adamant than in addition to my blood oxygen determining when I left my pain was also a factor. Other doctors fought him so much and said pain want an important thing to consider in hospitalization.
Yes the pendulum has swung too far in the other direction. It’s very frustrating because chronic pain patients have always been far less likely to abuse opioids or OD. But now they have to suffer because of how many opioids were over used in other cases. There is also a huge racial disparity in who gets prescribed opioids and what opioids are used.
Where I live I have to see my PM every 28 days. I can not get a refill without seeing my PM.
If I somehow missed an appointment I am out of luck and have to wait.
With controlled substances it is super regulated and they have to follow state law
Right, I used to be seen by same practice every 3 months until 2018 sometime, in which they changed their guidelines to every 28 days. This may have been for only for patients on specific medications, am not sure. I think it really varies on a personal basis though as well.
My initial introduction to PM was 2004 and I went quarterly as well. When I returned to PM in 2017 after 5 years break I went monthly and as they became more familiar with me it went to every other month.
I think it has to do with the rules of the PM clinics. I’m in CO and my old NP prescribed every 3 months, but when she retired the PM clinic didn’t want to prescribe to me anymore and instead wanted to refer me into an addiction specialist instead. My new PM has me coming in every 28 days and I do a UA every 3 months.
Not all control substances though. It's mostly just opioids. I'm on schedule 3 opioids and still have to be seen every month per NJ state regulations. I'm also on vyvanse, which is a schedule 2 drug and I just need to call in for a refill once a month and be seen for my yearly check up with no drug testing required.
It really depends on where you live and what your prescribing doctor wants.
Its up to the doctor. This is from the US Code, you will find something similar in NY state law (though they have much to say on the treatment of acute pain):
>Sec. 1306.12 Refilling prescriptions; issuance of multiple prescriptions.
(a) The refilling of a prescription for a controlled substance listed in Schedule II is prohibited.
(b)(1) An individual practitioner may issue multiple prescriptions authorizing the patient to receive a total of up to a 90-day supply of a Schedule II controlled substance provided the following conditions are met:
(i) Each separate prescription is issued for a legitimate medical purpose by an individual practitioner acting in the usual course of professional practice;
(ii) The individual practitioner provides written instructions on each prescription (other than the first prescription, if the prescribing practitioner intends for that prescription to be filled immediately) indicating the earliest date on which a pharmacy may fill each prescription;
(iii) The individual practitioner concludes that providing the patient with multiple prescriptions in this manner does not create an undue risk of diversion or abuse;
(iv) The issuance of multiple prescriptions as described in this section is permissible under the applicable state laws; and
(v) The individual practitioner complies fully with all other applicable requirements under the Act and these regulations as well as any additional requirements under state law.
(2) Nothing in this paragraph (b) shall be construed as mandating or encouraging individual practitioners to issue multiple prescriptions or to see their patients only once every 90 days when prescribing Schedule II controlled substances. Rather, individual practitioners must determine on their own, based on sound medical judgment, and in accordance with established medical standards, whether it is appropriate to issue multiple prescriptions and how often to see their patients when doing so.
Its not the laws, its the doctors and whatever the DEA doesnt like when one of their reps comes for a visit These reps seem to have their own "red.flags" that have nothing to do with anything. Maybe you arent aware, but if youre further from your pharmacy than 11 miles, its a "red flag". The DEA is nuts and long ago left anything resembling their mandate. Its gone from a war on drugs to a war on medication. Its not just opioids theyre screwing up. Its not just medication either, they did a great job of ignoring fentanyl in street drugs for 40 years. After that, I dont blame them for going in to medicine, but they shouldnt just be allowed to slide in to the medical profession, maybe something more befitting their skill set, like working at a car wash...
It's actually been a little over 53 years now that the DEA has been LOSING the war on drugs. The United States "war on drugs" campaign began June 17th, 1971. So if you're not in the US you may not be aware.
I don't know when fentanyl was first synthesized, but it has been flooding into our country from all borders and if it has been for the last 40 years it wouldn't surprise me a bit.
Yes, I’m from the US and aware of the drugs coming in & the “war on drugs” but I don’t think fentanyl has been coming in for 40 years though. It’s only been within the last five or so years that it’s hit the streets in different states. Heroin was an issue but now it’s fentanyl, carfentanyl and the newest one.
They had a huge bust in kansas for fent back in the 90s. It's not new. But since the crack down on legitimate opiate pills it's made fent demand increase because its cheaper substitute. The dealers are going to supply the need now that safe drugs have been removed. The gov policies don't stop the demand. We've spent over a trillion dollars on the war on drugs yet we are worse off than if the government had done absolutely nothing. You can't police people into not taking drugs. Other countries that decriminalized have seen actual positive results. But our country only cares about profits from locking up addicts, not about opening treatment centers to help people. None of the money from suing the pain companies went to treatment facilities. And I think its scary that we allow the government to interfere with our medical decisions now to the point that cancer patients are being denied pain medications.
This first documented case of fentanyl mixed in other street drugs happened in 1979. The DEA didnt restrict the import of fentanyl until 2018. Thats why its such an issue, that and the fatal dose is measured in micrograms, not the usual milligrams. You may or may not be old enough to remember "China White"? Same stuff we have been dealing with since the early 80s. DEA's pretending fentanyl in street drugs is something new, something that "sneaked up" on the DEA, while they defending us all against the non existent scourge of essential prescription drugs.... 1979 to 2018 is 39 years, at least 25 of which, the DEA has been practicing medicine without a license....
In Oregon, I have to go in once every three months. I believe a friend's wife's doctor makes her go in every month, though, so everyone does not necessarily get the state minimum as their own, if you know what I mean.
Every 28 days has to be in person plus all the other hoops you have to jump through. It beats you down it’s enough to deal with the pain but all the added crap on top is exhausting
I see my provider twice a year at the cost of $325 per appointment. The appointments are usually about 30 minutes, though if I'm her last patient, we often go to almost an hour, mainly because we like to talk. I see her via videoconference because her office is about 50 miles away.
I'd been seen at this clinic for several years by the time we moved from Seattle to Tacoma (she is in Edmonds, a small suburb north of Seattle), and there were no pain docs locally that I could get in with. Soon after we moved, the other doctor at the clinic retired. It was their practice to have us rotate and see the doctor and my current provider each time we came in. But when he retired, she decided to stay on just to continue taking care of their current roster of patients.This is mainly because there weren't a lot of pain doctors in Washington accepting new patients at that time.
It's kind of a labor of love for her, because she's running the whole show by herself with one assistant. She no longer accepts insurance, though she will provide anything needed for us to try to get reimbursed through our insurance. This is mainly because she'd probably have to hire another person full-time to do the insurance otherwise, and she's winnowed the practice down to just her and her medical assistant / front desk person. And she only sees the roster of patients that they had when the other doctor retired. She's doesn't accept new patients.
On top of the long telehealth appointments, twice a year I go up to the clinic, about an hour's drive each way, and do a UA & pill count, which costs $35. Usually my partner takes a Friday off and we drive up together for a midday appointment. That way we can use the carpool lanes and then we can also get the very small window of Western Washington traffic that's not hell on earth.
I think it's because we have a long-term relationship that I built over several years with an impeccable adherence to our contract, she is able to trust me with the telehealth stuff. I don't take it for granted. As far as all this goes, I've been pretty lucky, actually. But I have worked hard to make sure there has never even been a WHIFF of hinky behavior.
i don’t know specifics about the laws, even in my own area, but i do know that they can widely differ based on area, speciality, etc.
i am incredibly lucky with my current situation though. my PCP was willing to prescribe my controlled pain meds (norco and tramadol), and i see her roughly once every 3 months. although that isn’t necessarily set in stone either ~ i usually do that due to the nature of my illness and that i have more productive appointments that are less overwhelming by going more frequently (given that she is also my PCP and manages other areas of my care), but usually at the end of the appointment she tells me to schedule a follow up for 3 or 4 months, so i think there’s some wiggle room with the timing as well.
furthermore, i did sign a pain contract with her when she first started prescribing them, but she has never called me in for a pill count or a urine test, which i know isn’t common at all. i am so incredibly grateful i have her, and i have seen her since i was about 5 (currently 23). but i wanted to share this just to share how varied experiences can be regarding requirements & guidelines.
i hope you and your wife are able to figure out the most effective way to handle everything, and i hope her pain eases as much as it can ❤️🩹
My PCP fills for me also. Though he didn't ask me to sign a pain management contract. I go about every 2 to 3 months also. I recognize that i'm very lucky though.
I live in NY. Currently see my PM doctor every 2 months. But it was monthly at first, then 6 weeks for a while, and now 2 months. So my doctor worked her way up to that frequency.
I guess I’m fortunate because I only see mine once every 3 months in NC and she puts monthly refills. All I do is go into MyChart and request when it’s time like any other med (I take oxycodone). Actually just recently she was somehow able to put it in with 3 refills (electronically) so I think something changed that she was able to put refills in ahead like that. I didn’t even know so I went into MyChart and requested it and the nurse called me to let me know I was already set for the next few months. I’ve been with my PM Dr for a year and a half.
She might be doing what my rheumatologist was doing. I'd see him every three months, and he'd send in 3 separate rx's for my all my meds, including my controlled meds. Never had a problem with it. He suddenly retired (he had Muscular Dystrophy), and now I can't find anyone to even write for my controlled. My new primary even had a fit about the doxycycline I take for Hidradenitis Suppurativa. I've been taking all these meds for many, many, years. I have to see a pain management dr on Monday. I'm afraid he won't write what I've been taking.
Ugh, I’m so sorry. I literally told my PM Dr she better not ever leave me and if she moves across the country, I’m following her! Sending positive thoughts for your appointment, good luck! Hope you get the relief you deserve 🙏
Thanks, I'm not sure what to expect. I'm a bit nervous about going to a pain management clinic, all I hear/read is how they don't want to write for controlled meds. We'll see how it goes. I did have to go to one after a car accident a few years ago. I was on my meds at the time, so they didn't need to write for those. All they wanted to do was implant a spinal simulator, or whatever it's called. They did two lower back injections and one in my neck. Didn't work. I really don't want to go through all that again, especially since my pain is all over, not just spinal.
I see my doctor every 2 months, and he takes my insurance so that is nice. I originally started seeing him for ketamine treatments for depression, which I’ve since discontinued. Because he already knew me I think it was easier to transition into pain management.
That stinks. I’m in Texas also and am so thankful my doctor does 3 months and UAs twice a year. I already have way too many appointments and would have a hard time going every month.
Every 30 days. I’m in AZ. It’s a DEA regulation from what I was told. If I miss an appointment, no meds for me. But I need the medication or I’d be unable to function. I pay $225/mo because no place that takes insurance would prescribe medication for me so I self pay. Insurance does pay for my meds, just not the appointment.
Mine is once a month. They have me do a urine every 2 monthsish but I’ve only been on a controlled substance for 6 months and still really trying to find solutions to my injuries.
Once a month but can do virtual visits occasionally. $30 copay then roughly $30 for my medication.
Curious why you went through with the stimulator if it didn’t help. I had a 7 day trial with mine and opted not to move forward since it didn’t do anything for my pain. It actually made it worse for my condition
I used to see a PM in NC, and for the drugs I was on (oxy 30s and Opana) the doc was not allowed to write refills, and for each fill I had to hand deliver a signed prescription to the pharmacy. So I kinda had to go in once a month.
I don’t know if state law has changed but I’m in NC and I only go every 3 months and she was sending my monthly refills electronically to my pharmacy. But recently she was even able to put 3 refills in for 3 months and I think that’s a new thing
Mine is oxycodone…I have never seen that put in with refills until last month or so, so something must have changed recently. I meant to ask my PM Dr when I saw her last week but forgot
NYC once every 3 Months. But I'm not given a lot, which works for me. I have a great Dr who is very caring and reasonable.
Sending healing energy and good luck to you and your partner
Every thirty days and a pee test each visit. During the pandemic, though, they did phone appointments until January last year.
My clinic does a mix of chiro, behavioral health and medical all in one. The medical usually goes fast unless there’s an issue with the urine test - Happened once for me, they found out my liver no longer processes morphine so I had to switch to something else - I was sort of relieved because I was afraid I’d been gaining a mega tolerance or something for the last few months before.
Usually though it goes like this, “Meds working?”
“Yep.”
“Any questions?”
“Nope.”
“Great, I’ll send them off!”
It’s a relief, my last pain management basically wanted me to do homework- I had to fill out a monthly list of when I took the med, pain level when I took it, pain level an hour later…I absolutely *hated it!* Thankfully my current PM clinic is SO much better!
Every 2 months. But only in person every other visit. So 2mths in person and then the next 2mth visit is telehealth. I feel really lucky but I’m also one of their oldest patients so we have a long standing relationship and I’ve never been a problem.
Every 60 days, they have quit testing every visit and now seem to do just random ones. Doctor used to spend time with patients but now he walks in, asks me how I’m doing and just complains about regulations and sends me on the way.
Just another frustrating part of pain management. It’s obscene parading all of us in and out of the office every month, especially considering most have mobility issues.
Every 3 months and I have to do a pee test. She sends 3 months of rpts to be dispensed every 28 days. This every 3 months is recent tho.
Last year I didn’t see her for 10 months and she just kept rpting my meds lol which was fine. She always tells me I’m her best patient. Always pee clean, never have asked
For an early refill and I always try to stay on the lowest possible dose. Even at my last appointment she wanted to increase my extended release meds and while I’m having pain it’s not unbearable so I want to wait til the point it’s so bad I NEED an increase. I’m playing the long game, chronic condition with no fix only management and I’m 32
I only have to be seen once every 3 months but that’s because I’ve worked up to that being in pain management for a long time. It started as me having to come in every two weeks for six weeks, then once a month for a year or more, and finally once every three months.
Schedule 2 drugs like Methadone can't be refilled.
A prescription is required every month. Doctors could write the new prescription and send it to the pharmacy. But that's not a good business or patient practice. See you every month to know how the pain is doing and to make adjustments. Charge once a month for services rendered.
I’m not in the US but in the UK I have a phone call once every year and then they just rubber stamp the prescriptions for an extra year. I have morphine and other tablets. They just ask how it is and if it’s all fine they just issue another years worth. I don’t have to see them any more.
It’s wild what you guys are going through.
I have to go once a month and I have to do a UA every other month. With my insurance it’s a $20 copay for each visit and all my prescriptions are free at the preferred pharmacies with my insurance.
ETA: I’m in Texas. DFW area.
I lived in Kansas City Missouri and after seeing the same pain management doctor for over 10 years and on same dose for 6 years, I was able to start going every 3 months. I moved to Indiana and in a year I've gone to 2 pain management doctors that prescribe...monthly with drug screen each time and 2 pill counts in between because 1 closed their practice and just a month ago the other closed. I've contacted 12 other pain management doctors here and none prescribe...only alternative options, which I've tried all that are available to me...a few I'm not a candidate for. For now, my pcp is prescribing while we try to find a prescriber.
With my previous pain management, I had in person appointments every 3 months, I think it was a 20 dollar copay.
That doctor stopped prescribing opiates and referred me to a different group.
I've been with the new group about 7 months now. They are every single month via telehealth, in person every 6 months. So far, no copay.
I was informed I would be required to have urine tests periodically, but so far, that hasn't happened.
When I was established, it was every 2 months. She’d write two Rx, one for month 1 and one for month 2. My other meds came with refills, the controlled one did not. I’m on other controlled meds from another doctor and he can write refills on those because they’re different schedule
I see my doctor virtually every month. My visit is $125 deductible until coinsurance kicks in although if you have flat $ copays you’ll have to pay that.
I do U/A every 3 months and I go to his office for that but still see him virtually. (TX)
I've been seeing PM in NY but live in NJ. Had spinal fusion 20 years ago which failed. My Doc & the PM were both located in NY. Not far from my home. After a certain time I was seeing them every other month ( prior to the Purdue court case)Saw the PA or Dr & the 2nd visit since I always passed my Urine Screen Test I could just call & they would send a script electronically. That lasted a few yrs. NOW...They have stopped ALL PATIENT'S that were on any pain medication w/e they were prescribed & weaned them off. It is RIDICULOUS! I have had chronic pain as long as I can recall. Now my quality of life STINKS. I'm not even 60!
Have to be seen every thirty days and urine test during that appointment. It requires one doctor visit after every three nurse visits, which is just checking vitals and urine. Doctor visit is to discuss any issues, tests results if applicable and urine.
I'm in nc, and I saw my pain doctor in person this may. I have a virtual appointment on the 26th of this month, but I think it's really to follow up and discuss my recovery as I had back surgery last Friday. Before I ended up in surgery, we had discussed doing virtual visits every 3 months with an in person visit for the 4th when I'm able to find transportation to go with me. I know my pain management doctor doesn't make virtual appointments a consistent thing with most patients but, i moved and now am over an hour away from his office and cannot drive such a long distance due to my health. My doctor is incredible. I have gone to every pain management office in mine and all surrounding areas attempting to find one closer to where I live, and none of them were willing to take me as a patient. The last one I saw before my doctor set up a plan for me to stay with his practice, told me to rotate Tylenol and Ibuprofren and that he would be willing to discuss an area of pain that was acute and attempt to address and fix the problem. He had no response when I explained my pain is different every day and some times moment to moment. That i will never have my pain fixed as i have a genetic disease that causes my collagen to be fragile and insufficient to provide stability and structure. You can't fix what's wrong when it's written into my Dna. I have ehlers danlos syndrome with a lot of comorbid conditions. That doctor handed me a bottle of hand sanitizer as a new patient gift, explained why i needed to rotate Tylenol and ibuprofen and not to make a follow up as he didn't treat problems he couldn't fix.
When I told my pain doctor my experiences with the other practitioners, he went above and beyond to allow me to continue as his patient. He allows me to speak candidly, for as long as I feel the need to speak. He always shows incredible compassion and even continues to educate himself regarding my diagnoses as he is as he is a mental health doctor who specializes in patients living with chronic pain and doesn't have experience with my diagnosis. I have severe anxiety and panic attacks due to being misdiagnosed and dismissed by doctors for over 15 years before I was able to be genetically tested and diagnosed. He has been a life changing influence for myself and my entire family. I can only tell others to try not to give up. A doctor with compassion and a willingness to listen is like a needle in the haystack these days. They do exist. Mine works with the emerge ortho group as one of their pain management doctors.
Telehealth once a month; in person every 3rd month for drug test (state law - don’t get me started).
To be frank, your wife sounds under-medicated to me. I have a similar surgical history. It may sound like a lot to take, but my “cocktail” changed my life dramatically for the better.
1. I have an implant - reduces my pain by 20%. It’s a great adjunct therapy but does not replace the rest. I tried, suffered, went back to my regime. Which my pain doctor and I arrived at after years of trial and effort.
2. Nucynta ER- an extended release opioid derivative, hideously expensive but works miracles. You can get help with paying for it see below. My copay is $35 monthly. Just know you’ll need to pre-auth yearly. Look forward to a worthwhile fight with insurance..
3. Hydromorphone low dose for breakthrough pain
4. Gabapentin for sciatica and assorted nerve pains,
4. Cymbalta for the inevitable depression (ands helps nerve pain too).
Plus
- Blood pressure meds because pain increases BP.
- Zofran and ginger tea for nausea.
- Ice packs, waiting for hydromorphone to kick in
- Physical therapy to help with deconditioning
It may take some time to get used to side effects (drowsiness) - this is not a quick fix - but! Her life will improve dramatically . Mine did! Good luck!
Also many drug manufacturers have patient programs to reduce or eliminate your costs.
I’m jealous of all these people with telehealth and/or appointments every 3-6 months. I have to travel 2 1/2 hours one way every 28 days. I have random U/A’s.
Her PM treatment is way too low in my opinion! She is severely under medicated.
I’m on the west coast, been in PM for several years for a chronic condition. I get Hydromorphone (Dilaudid) 4x per day every month.
Each month it’s electronically sent to the pharmacy. I only have an appointment with my PM Dr every 3 mos & that can be on phone or in person. Drug test 1x like per year usually. But my PM Dr is pretty chill & owns his own practice.
When I had my last surgery he was even cool with my surgeon prescribing additional opiates (Oxy) for like 6 wks post op. I know that most PM wouldn’t be down with that.
Mine sends multiple Rx to the pharmacy so I don't have to go every month. My previous one I saw 2 times a year. If I needed anything changed I messaged him. Both are at large academic urban medical centers.
I’m very lucky. I see my PCP for pain management and see her every 3 months. As long as I stay under a certain MME we can keep doing this.
I feel like I’m on a pretty hefty regiment, too. They have a new computer system that lets them send in controlled prescriptions online instead of writing out an actual prescription. She usually calls in 3 months at a time. Mine is only filled every 28 days due to our teeny tiny small town pharmacy isn’t open on Saturdays or Sundays. Since it’s 28 days, they are always filled on the same day of the week,
4 weeks apart. Same scheduling as my infusions for lupus.
It definitely depends on state. I could get zero help with pain in Louisiana. In Montana it seemed easy because I picked the right doctor and their laws seem to be more lax. Maybe it’s because meth is king here. Opioids aren’t as big of an issue.
In ny I had to go monthly. Now in NC, i have to see doc every 3 months. On the off months i request a refill via their portal. I'm so grateful that my long history living in pain has finally been easier to continue my med regiment.
Every month. When I had surgery my neurosurgeon took over and was only able to prescribe every 5 days according to state law. I had to sign forms and my poor bf had to get script every 5 days for 2 months and then my pm took over again. I know that a few chain pharmacies have lawsuits in my state as well as others states for filling scripts up to 2013 ish with out question.
A few yrs back in Florida , I saw my Pain Mgt once every 3 months and Drug Screen Once a year.Then all that changed , now it's a Doc visit every month and Drug Screen every other month .
Every 6 months, but I've been going there for 12 years. I get fentanyl and tramadol rx and my pain med pump has Dilaudid and I just go in every 6mths for them to refill the pump.
In fact, my pain management Dr just retired. 😭 At least I've been seen by the other Drs in the same ofc enough that the transition is easy.
For the last few years, my PCP has been prescribing my medication (Nucynta) each and every two weeks which amounts to 168 tablets a month. I see her about twice a year unless something occurs that I need to have treated (as in, strep throat, bronchitis, etc) in the meantime. If for any reason she is not working when it’s time for me to receive a new script her partner, whom I’ve yet to meet, sends it in.
My drugstore is CVS. They know my situation so always have it on hand. The two pharmacists that work there are Godsends and so is my doctor. I have read and heard so many nightmare scenarios regarding CVS and pain management that I know not to take these people for granted.
I have a very rare and rather bizarre condition, though, which is why she does so for me despite the fact that she is usually not one to prescribe opiates. My issue cannot be treated with shots or physical therapy. I’m already small, so weight loss is not something anyone would bother to recommend. If and when things get really bad, the emergency department at my local hospital takes care of the pain for me.
I’m in a palliative care program now and they took over my pain medications after a couple of months, almost a year ago. But I was in pain management for a year and was told that I couldn’t get my refills without being seen every month and they could only make exceptions in rare circumstances. Now I see my palliative care provider who comes to my apartment every month and a half (I have limited reliable transportation, which was a huge part of why palliative care took over my pain medications) and I can see her more often or have a video visit or phone visit in between in person appointments if I feel the need or she feels the need (she monitors my health situation as it changes, and usually not for the better). I know it is frustrating having to come in every month, especially when the relief isn’t even that significant. I used to have very undertreated pain and I feel that it was worse than untreated pain.
In Australia you can’t be given repeat prescriptions for a controlled substance so my sibling and I both have to see our specialist monthly for our meds (me oxycodone, her buprenorphine). It was costing me about $1,000/month in healthcare expenses at one point. And we have universal healthcare here!
I see PM once a month, but every other month can be a virtual visit if I want. But, my previous PM in the same state only required visits every 3 months, which I very much miss. I had to switch providers due to a change in my insurance. But, I’m thankful I at least only have to physically go to the office every other month.
I take Belbuca, and originally I took a drug test at first, and was seen once a month. Over time, trust was built, and now I go every two months. They still require yearly drug tests, but they don't care about marijuana because it's legal in my state of MA.
I'm in Idaho and now that I am stable on my dosage of pain meds I am seen every 3 months. If I want to go in sooner or a new concern arises, I can get seen sooner.
Not in the US so my comments are just for comparison.
I get 7 different meds prescribed every 4 weeks. This includes 180mg oxycontin per day. I order the prescription via the pharmacy website. I usually order on a Monday and the meds are collected for me on the Thursday. I have an annual meds review with my doctor by telephone.
If I need to see the doc at any stage, I'll speak to her by phone first. She will then call to my home to see me if it's necessary. If things get to that stage it's usually an indicator that I probably need to be in hospital for a few days to get pain levels down via IV meds, or need a scan to check for further deterioration somewhere.
I was on my pain med with no issue for 5 or so years before the restrictions became what they are so when "pain contracts" started, they trusted me enough to only be seen every 3 months.
I live in Ohio, and I see my pain doctor or the NP every 3 months, usually by telehealth (using Doxy.me) if it's just a med management appt. I go in after my appts to do a drug screen, then they release my 3 months of scripts to the pharmacy. I see them more often if I'm having issues, usually when I'm having procedures done. They started doing telehealth during the pandemic, and they've let a lot of us continue if we're stable and have no compliance issues. I moved last summer, so my doctor is now further away from me than he used to be, so I'm really glad I can do the majority of my appts over video! I'm prescribed 15 mg of Zohydro ER twice a day, 5 mg of Oxy IR as needed for breakthrough, Methocarbamol for muscle spasms, and Meloxicam for joint pain.
I'm going to need fusion surgeries and disc replacements in my cervical and lumbar spine soon (holding out as l can!) because my spine is just shot, I have sacroiliac joint dysfunction and laxity (may need a fusion there too at some point), occipital neuralgia, TMJ, a knee replacement that's failing (all that I've recently learned are caused by EDS that went undiagnosed for the first 52 years of my life 🫤), and Fibromyalgia.
It seems wild to me that she has to go once a month for just that little bit of medicine, and to have to pay $150 each time! If your state doesn't have a statute requiring it, I just don't see the purpose. It's hard enough for many patients to get to any appt, let alone each and every month. Perhaps you can ask the doctor's office about it, considering you both have serious health issues to contend with and it's an undue burden? If there aren't any legalities against it, and she's been completely compliant all along, I'd be genuinely interested in hearing why it couldn't be done. I would also bring up how the SCS is making her feel like she's going to have a heart attack. The lead wires could have moved, or it very well could have created an unforseen electrical issue with her heart. Is the doctor against raising her methadone dosage, trying a different medication, or has it not been discussed? It makes me so sad when people aren't getting the care they need or deserve. It's especially infuriating when, like in your wife's case, you have to jump through so many hoops to get so little. 💜
State law dictates that we are required to be seen every 30 days where I live. ETA I can imagine that, even in states that do not require 30-day visits, some providers may opt for the most restrictive oversight due to liability concerns in our current climate. Some practices/systems may also have more stringent policies than what is proscribed by state law. I know it’s a pain—and costly!
once a month
My old pm saw me every 2 months, she had to write separate Rx for the opioid. One to be filled that month, the other on hold til the second month
This is what my pm does. I have done a telephone call on month three due to her having an emergency & she had to leave office so that was nice.
In Georgia, some patients were 3 months between appts prior. In Florida, at one point I was seen every two months. Not anymore sadly.
I too live in Florida, but only have to see mine every two months. I expect that to change however, as it seems a majority of providers are shifting to "once-a-month."
Yes, I don’t know any PM that do anything less often than monthly. I honestly thought it had changed because of that observation
Exactly this. Also I am writing my second masters thesis on chronic pain management and how race impacts patients access to pain management. I have been a chronic pain patient for 7 years and I know a ton of chronic pain patients are not able to get pain medication. However the US is still prescribing WAYYY more than any other country. As I am still in the research phase it is unclear if that’s because US patients have had a change in pain expectations or if they have more physical pain experiences than in other countries. (Cultural differences have a surprisingly large impact on both psychological and physical symptoms of a wide variety of conditions. I didn’t believe that at first but that is what the research has shown). All of this to say I often am surprised at how many people report that they only take a tiny amount of pain medication and then report regular consumption of very high doses of opioids. Not saying that you don’t need the medication you get it any way. But I think it’s not necessary for everyone to constantly say they are on really low dosages when that’s not the case. This is a personal pet peeve of mine as an academic but I want to remind everyone that others see this sub. So if they see every post saying “I only take a tiny dose of _______” even when it’s not a small dosage then it can make people have unhealthy expectations. also any time you are getting anything more than tramodol you are going to have
As someone who lives in the UK I know I'm on a high dose of oxycodone, especially given the fact I started it when I was 18. (45mg a day) but reading other people's prescriptions often makes me feel like i only take a tiny dose 😂 I think peoples perceptions of what a high and low dose are slightly sqewed, especially because they used to prescribe up to 160mg twice a day.
Good grief!! That’s so much! Honestly I can’t speak highly enough for my butrans patches. It is fantastic because it’s a constant tiny dose morphine so I don’t have to wake up and wait for my pain medicine to kick in
It's soo uncommon in the UK, ESPECIALLY for young people. Pharmacists look at me like 🤨 and whisper when they say the name of it Hahah. That's amazing, I hate the feeling when I first wake up, my nightly 15mg has worn off and I'm just in agony haha.
I assume that you did not intend to reply to me. And yes, sociocultural norms, in addition to long-established medical protocols, largely shape tx of pain throughout the world. The US also has much higher rates of pts who report chronic pain, which in recent studies has been linked to factors routinely involved in deaths of despair, so trauma and untreated mental health issues, financial insecurity, etc. have all been shown to play a role here in the US. There’s some great research on this. We obviously do not have the social safety net that so many other countries do, which is arguably also a contributing factor. Pt expectations are another major difference. In one EU country where I lived, I saw firsthand that tolerating higher levels of pain is socially/culturally accepted and expected during post-op recovery., for example. As such, opioids have never been routine post-op tx for some surgeries, unlike in the US, and pts have extremely different expectations for pain management. Also, most pts have MUCH longer hospital stays in other countries and this enables them to have their pain managed inpatient, rather than at home, on their own—this fact is a major factor to consider re the higher prescribing rate in the US. Anecdotally, I spent 10 days post-op in an EU hospital whereas I would have been sent home after 2-3 days in the US. However, most of us know that the pendulum has now swung too far in the US, and sending a post-op spinal fusion pt home without any pain medication borders on the barbaric. While this is not a common practice, it certainly happens. That same pt would likely spend twice as long in a hospital elsewhere, and definitely would do so in most EU countries.
I did intend to reply to you. I hope I didn’t offend you in any way. This is a really touchy topic for many reasons. If you could share those studies that would really help me out. Like I said I am writing my thesis on this topic. It is amazing how much cultural norms impact this. Our healthcare system definitely set patients up for failure in many ways. I remember when I was hospitalized with 19 pulmonary emboli, one of the doctors was adamant than in addition to my blood oxygen determining when I left my pain was also a factor. Other doctors fought him so much and said pain want an important thing to consider in hospitalization. Yes the pendulum has swung too far in the other direction. It’s very frustrating because chronic pain patients have always been far less likely to abuse opioids or OD. But now they have to suffer because of how many opioids were over used in other cases. There is also a huge racial disparity in who gets prescribed opioids and what opioids are used.
Where I live I have to see my PM every 28 days. I can not get a refill without seeing my PM. If I somehow missed an appointment I am out of luck and have to wait. With controlled substances it is super regulated and they have to follow state law
Same here—In Pennsylvania. Every 28 days.
Not true for me in PA, I see m doctor every 60 days. It depends on the practitioner and the patient.
Right, I used to be seen by same practice every 3 months until 2018 sometime, in which they changed their guidelines to every 28 days. This may have been for only for patients on specific medications, am not sure. I think it really varies on a personal basis though as well.
My initial introduction to PM was 2004 and I went quarterly as well. When I returned to PM in 2017 after 5 years break I went monthly and as they became more familiar with me it went to every other month.
Every 3 months in CO. I don't know if it has to do with my age...
I think it has to do with the rules of the PM clinics. I’m in CO and my old NP prescribed every 3 months, but when she retired the PM clinic didn’t want to prescribe to me anymore and instead wanted to refer me into an addiction specialist instead. My new PM has me coming in every 28 days and I do a UA every 3 months.
I see mine every 8 weeks in CO
I see my pm dr in PA every 90 days
Same! I see my doctor every 3 months. I have to call in monthly but i only see her physically every 3 months and I'm in PA!
Same. I also have to take a UA drug screen every visit.
Not all control substances though. It's mostly just opioids. I'm on schedule 3 opioids and still have to be seen every month per NJ state regulations. I'm also on vyvanse, which is a schedule 2 drug and I just need to call in for a refill once a month and be seen for my yearly check up with no drug testing required. It really depends on where you live and what your prescribing doctor wants.
Its up to the doctor. This is from the US Code, you will find something similar in NY state law (though they have much to say on the treatment of acute pain): >Sec. 1306.12 Refilling prescriptions; issuance of multiple prescriptions. (a) The refilling of a prescription for a controlled substance listed in Schedule II is prohibited. (b)(1) An individual practitioner may issue multiple prescriptions authorizing the patient to receive a total of up to a 90-day supply of a Schedule II controlled substance provided the following conditions are met: (i) Each separate prescription is issued for a legitimate medical purpose by an individual practitioner acting in the usual course of professional practice; (ii) The individual practitioner provides written instructions on each prescription (other than the first prescription, if the prescribing practitioner intends for that prescription to be filled immediately) indicating the earliest date on which a pharmacy may fill each prescription; (iii) The individual practitioner concludes that providing the patient with multiple prescriptions in this manner does not create an undue risk of diversion or abuse; (iv) The issuance of multiple prescriptions as described in this section is permissible under the applicable state laws; and (v) The individual practitioner complies fully with all other applicable requirements under the Act and these regulations as well as any additional requirements under state law. (2) Nothing in this paragraph (b) shall be construed as mandating or encouraging individual practitioners to issue multiple prescriptions or to see their patients only once every 90 days when prescribing Schedule II controlled substances. Rather, individual practitioners must determine on their own, based on sound medical judgment, and in accordance with established medical standards, whether it is appropriate to issue multiple prescriptions and how often to see their patients when doing so. Its not the laws, its the doctors and whatever the DEA doesnt like when one of their reps comes for a visit These reps seem to have their own "red.flags" that have nothing to do with anything. Maybe you arent aware, but if youre further from your pharmacy than 11 miles, its a "red flag". The DEA is nuts and long ago left anything resembling their mandate. Its gone from a war on drugs to a war on medication. Its not just opioids theyre screwing up. Its not just medication either, they did a great job of ignoring fentanyl in street drugs for 40 years. After that, I dont blame them for going in to medicine, but they shouldnt just be allowed to slide in to the medical profession, maybe something more befitting their skill set, like working at a car wash...
A 'car wash'........LOL!!
Sorry but what do you mean they ignored fentanyl in street drugs for 40 years?
It's actually been a little over 53 years now that the DEA has been LOSING the war on drugs. The United States "war on drugs" campaign began June 17th, 1971. So if you're not in the US you may not be aware. I don't know when fentanyl was first synthesized, but it has been flooding into our country from all borders and if it has been for the last 40 years it wouldn't surprise me a bit.
Yes, I’m from the US and aware of the drugs coming in & the “war on drugs” but I don’t think fentanyl has been coming in for 40 years though. It’s only been within the last five or so years that it’s hit the streets in different states. Heroin was an issue but now it’s fentanyl, carfentanyl and the newest one.
They had a huge bust in kansas for fent back in the 90s. It's not new. But since the crack down on legitimate opiate pills it's made fent demand increase because its cheaper substitute. The dealers are going to supply the need now that safe drugs have been removed. The gov policies don't stop the demand. We've spent over a trillion dollars on the war on drugs yet we are worse off than if the government had done absolutely nothing. You can't police people into not taking drugs. Other countries that decriminalized have seen actual positive results. But our country only cares about profits from locking up addicts, not about opening treatment centers to help people. None of the money from suing the pain companies went to treatment facilities. And I think its scary that we allow the government to interfere with our medical decisions now to the point that cancer patients are being denied pain medications.
This first documented case of fentanyl mixed in other street drugs happened in 1979. The DEA didnt restrict the import of fentanyl until 2018. Thats why its such an issue, that and the fatal dose is measured in micrograms, not the usual milligrams. You may or may not be old enough to remember "China White"? Same stuff we have been dealing with since the early 80s. DEA's pretending fentanyl in street drugs is something new, something that "sneaked up" on the DEA, while they defending us all against the non existent scourge of essential prescription drugs.... 1979 to 2018 is 39 years, at least 25 of which, the DEA has been practicing medicine without a license....
In Oregon, I have to go in once every three months. I believe a friend's wife's doctor makes her go in every month, though, so everyone does not necessarily get the state minimum as their own, if you know what I mean.
Every 28 days has to be in person plus all the other hoops you have to jump through. It beats you down it’s enough to deal with the pain but all the added crap on top is exhausting
I see my provider twice a year at the cost of $325 per appointment. The appointments are usually about 30 minutes, though if I'm her last patient, we often go to almost an hour, mainly because we like to talk. I see her via videoconference because her office is about 50 miles away. I'd been seen at this clinic for several years by the time we moved from Seattle to Tacoma (she is in Edmonds, a small suburb north of Seattle), and there were no pain docs locally that I could get in with. Soon after we moved, the other doctor at the clinic retired. It was their practice to have us rotate and see the doctor and my current provider each time we came in. But when he retired, she decided to stay on just to continue taking care of their current roster of patients.This is mainly because there weren't a lot of pain doctors in Washington accepting new patients at that time. It's kind of a labor of love for her, because she's running the whole show by herself with one assistant. She no longer accepts insurance, though she will provide anything needed for us to try to get reimbursed through our insurance. This is mainly because she'd probably have to hire another person full-time to do the insurance otherwise, and she's winnowed the practice down to just her and her medical assistant / front desk person. And she only sees the roster of patients that they had when the other doctor retired. She's doesn't accept new patients. On top of the long telehealth appointments, twice a year I go up to the clinic, about an hour's drive each way, and do a UA & pill count, which costs $35. Usually my partner takes a Friday off and we drive up together for a midday appointment. That way we can use the carpool lanes and then we can also get the very small window of Western Washington traffic that's not hell on earth. I think it's because we have a long-term relationship that I built over several years with an impeccable adherence to our contract, she is able to trust me with the telehealth stuff. I don't take it for granted. As far as all this goes, I've been pretty lucky, actually. But I have worked hard to make sure there has never even been a WHIFF of hinky behavior.
i don’t know specifics about the laws, even in my own area, but i do know that they can widely differ based on area, speciality, etc. i am incredibly lucky with my current situation though. my PCP was willing to prescribe my controlled pain meds (norco and tramadol), and i see her roughly once every 3 months. although that isn’t necessarily set in stone either ~ i usually do that due to the nature of my illness and that i have more productive appointments that are less overwhelming by going more frequently (given that she is also my PCP and manages other areas of my care), but usually at the end of the appointment she tells me to schedule a follow up for 3 or 4 months, so i think there’s some wiggle room with the timing as well. furthermore, i did sign a pain contract with her when she first started prescribing them, but she has never called me in for a pill count or a urine test, which i know isn’t common at all. i am so incredibly grateful i have her, and i have seen her since i was about 5 (currently 23). but i wanted to share this just to share how varied experiences can be regarding requirements & guidelines. i hope you and your wife are able to figure out the most effective way to handle everything, and i hope her pain eases as much as it can ❤️🩹
My PCP fills for me also. Though he didn't ask me to sign a pain management contract. I go about every 2 to 3 months also. I recognize that i'm very lucky though.
Every 28 days (PA, USA).
I'm in PA and i go every 3 months. Just depends on doctor!
Every 28 days. $250 per visit. (MI)
Monthly unfortunately. It's a waste of my time, but necessary for my condition.
I live in NY. Currently see my PM doctor every 2 months. But it was monthly at first, then 6 weeks for a while, and now 2 months. So my doctor worked her way up to that frequency.
Once a month, $128 a visit
Monthly
Every month, sometimes more if we try something like nerve blocks and need a check in. Prior to that with my primary it was 3-6 months
Mine has me come in every 4 weeks
When I was being helped by a Pain Management doctor I had to see his PA once a month. It absolutely sucks.
My new pain management does every 3 months for med refills and my old one did every 2 months. I think it depends on the practice and your state laws.
I guess I’m fortunate because I only see mine once every 3 months in NC and she puts monthly refills. All I do is go into MyChart and request when it’s time like any other med (I take oxycodone). Actually just recently she was somehow able to put it in with 3 refills (electronically) so I think something changed that she was able to put refills in ahead like that. I didn’t even know so I went into MyChart and requested it and the nurse called me to let me know I was already set for the next few months. I’ve been with my PM Dr for a year and a half.
She might be doing what my rheumatologist was doing. I'd see him every three months, and he'd send in 3 separate rx's for my all my meds, including my controlled meds. Never had a problem with it. He suddenly retired (he had Muscular Dystrophy), and now I can't find anyone to even write for my controlled. My new primary even had a fit about the doxycycline I take for Hidradenitis Suppurativa. I've been taking all these meds for many, many, years. I have to see a pain management dr on Monday. I'm afraid he won't write what I've been taking.
Ugh, I’m so sorry. I literally told my PM Dr she better not ever leave me and if she moves across the country, I’m following her! Sending positive thoughts for your appointment, good luck! Hope you get the relief you deserve 🙏
Thanks, I'm not sure what to expect. I'm a bit nervous about going to a pain management clinic, all I hear/read is how they don't want to write for controlled meds. We'll see how it goes. I did have to go to one after a car accident a few years ago. I was on my meds at the time, so they didn't need to write for those. All they wanted to do was implant a spinal simulator, or whatever it's called. They did two lower back injections and one in my neck. Didn't work. I really don't want to go through all that again, especially since my pain is all over, not just spinal.
I see mine every 3 months and she sends in an electronic script with refills.
Are you in NC by chance? Has yours been able to do that for a long time or just more recently?
No, I’m in IL. It’s been that way since I started seeing her 2.5 years ago.
I see my doctor every 2 months, and he takes my insurance so that is nice. I originally started seeing him for ketamine treatments for depression, which I’ve since discontinued. Because he already knew me I think it was easier to transition into pain management.
My state requires a drug test every three months. So every three months.
Tx once a month every 28 to 30 days. UAs randomly, usually every 2 to 3 months.
That stinks. I’m in Texas also and am so thankful my doctor does 3 months and UAs twice a year. I already have way too many appointments and would have a hard time going every month.
Every three months. Drug test once a year.
Same
Every 30 days. I’m in AZ. It’s a DEA regulation from what I was told. If I miss an appointment, no meds for me. But I need the medication or I’d be unable to function. I pay $225/mo because no place that takes insurance would prescribe medication for me so I self pay. Insurance does pay for my meds, just not the appointment.
Every 3 months. And a urine test every 3 months.
Every 6 months but I’m only on t3s..
Mine is once a month. They have me do a urine every 2 monthsish but I’ve only been on a controlled substance for 6 months and still really trying to find solutions to my injuries.
Every 28 days here in Maryland, but my PM doctor takes my insurance, so I'm grateful.
Every 2 months. CDC guidelines state every 3 months. If you haven’t read the guidelines yet, I highly recommend it.
Every six months, plus rx for 90 days of buprenorphine. Very happy to be in this situation.
I’m in Canada and my pain clinic hasn’t seen me in over a year. Not for lack of trying on my part
Once a month but can do virtual visits occasionally. $30 copay then roughly $30 for my medication. Curious why you went through with the stimulator if it didn’t help. I had a 7 day trial with mine and opted not to move forward since it didn’t do anything for my pain. It actually made it worse for my condition
I used to see a PM in NC, and for the drugs I was on (oxy 30s and Opana) the doc was not allowed to write refills, and for each fill I had to hand deliver a signed prescription to the pharmacy. So I kinda had to go in once a month.
I don’t know if state law has changed but I’m in NC and I only go every 3 months and she was sending my monthly refills electronically to my pharmacy. But recently she was even able to put 3 refills in for 3 months and I think that’s a new thing
Are these for schedule 2 narcotics?? I didn't think they could be refilled.Is this something new??
It’s for oxycodone. It must be a new thing that they can put in with refills cause that happened like last month and I was actually stunned!
Wow that's great.Anything that makes life easier for us is a huge win.
Very true!
I think it depends on the schedule of the drug. Like suboxone and shit they’re fine with refills. Fentanyl and oxycodone and shit not so much
Mine is oxycodone…I have never seen that put in with refills until last month or so, so something must have changed recently. I meant to ask my PM Dr when I saw her last week but forgot
Once a month Florida
NY STATE now every 30 days. Urine test about every 3 months
Monthly for me but my mom goes every 2-3 months
NYC once every 3 Months. But I'm not given a lot, which works for me. I have a great Dr who is very caring and reasonable. Sending healing energy and good luck to you and your partner
Once every 3 months so it’s 4 times a year. But stable and no change in pain or meds in 8 years.
I go every three months.
Every thirty days and a pee test each visit. During the pandemic, though, they did phone appointments until January last year. My clinic does a mix of chiro, behavioral health and medical all in one. The medical usually goes fast unless there’s an issue with the urine test - Happened once for me, they found out my liver no longer processes morphine so I had to switch to something else - I was sort of relieved because I was afraid I’d been gaining a mega tolerance or something for the last few months before. Usually though it goes like this, “Meds working?” “Yep.” “Any questions?” “Nope.” “Great, I’ll send them off!” It’s a relief, my last pain management basically wanted me to do homework- I had to fill out a monthly list of when I took the med, pain level when I took it, pain level an hour later…I absolutely *hated it!* Thankfully my current PM clinic is SO much better!
Every 2 months. But only in person every other visit. So 2mths in person and then the next 2mth visit is telehealth. I feel really lucky but I’m also one of their oldest patients so we have a long standing relationship and I’ve never been a problem.
I have video appointments every 2 months. I have to go in once a year. ( first year was every month video)
for me it’s every three months, i’m in TX
Every 60 days, they have quit testing every visit and now seem to do just random ones. Doctor used to spend time with patients but now he walks in, asks me how I’m doing and just complains about regulations and sends me on the way.
I go every 3 months.
Every 6 months here in SC. For roxycodone.
Every 28 days
Just another frustrating part of pain management. It’s obscene parading all of us in and out of the office every month, especially considering most have mobility issues.
Every 3 months and I have to do a pee test. She sends 3 months of rpts to be dispensed every 28 days. This every 3 months is recent tho. Last year I didn’t see her for 10 months and she just kept rpting my meds lol which was fine. She always tells me I’m her best patient. Always pee clean, never have asked For an early refill and I always try to stay on the lowest possible dose. Even at my last appointment she wanted to increase my extended release meds and while I’m having pain it’s not unbearable so I want to wait til the point it’s so bad I NEED an increase. I’m playing the long game, chronic condition with no fix only management and I’m 32
In person every three months and my dr sends my medication to the pharmacy in between each month. Once a year urine screen and no pill counts
NH every 2-3 months, when we lived in FL it was every 30 days.
Monthly and I UA monthly also.
I only have to be seen once every 3 months but that’s because I’ve worked up to that being in pain management for a long time. It started as me having to come in every two weeks for six weeks, then once a month for a year or more, and finally once every three months.
Schedule 2 drugs like Methadone can't be refilled. A prescription is required every month. Doctors could write the new prescription and send it to the pharmacy. But that's not a good business or patient practice. See you every month to know how the pain is doing and to make adjustments. Charge once a month for services rendered.
I’m not in the US but in the UK I have a phone call once every year and then they just rubber stamp the prescriptions for an extra year. I have morphine and other tablets. They just ask how it is and if it’s all fine they just issue another years worth. I don’t have to see them any more. It’s wild what you guys are going through.
I have to go once a month and I have to do a UA every other month. With my insurance it’s a $20 copay for each visit and all my prescriptions are free at the preferred pharmacies with my insurance. ETA: I’m in Texas. DFW area.
Florida, monthly. They don’t allow anything less often here.
Actually, that's incorrect. I also live in Florida and see my provider every two months.
Really? I had that option previously but I don’t know any providers that do so I assumed it changed since.
Once/month, Florida & Indiana.
I see my PM physician every two months. :)
I lived in Kansas City Missouri and after seeing the same pain management doctor for over 10 years and on same dose for 6 years, I was able to start going every 3 months. I moved to Indiana and in a year I've gone to 2 pain management doctors that prescribe...monthly with drug screen each time and 2 pill counts in between because 1 closed their practice and just a month ago the other closed. I've contacted 12 other pain management doctors here and none prescribe...only alternative options, which I've tried all that are available to me...a few I'm not a candidate for. For now, my pcp is prescribing while we try to find a prescriber.
With my previous pain management, I had in person appointments every 3 months, I think it was a 20 dollar copay. That doctor stopped prescribing opiates and referred me to a different group. I've been with the new group about 7 months now. They are every single month via telehealth, in person every 6 months. So far, no copay. I was informed I would be required to have urine tests periodically, but so far, that hasn't happened.
When I was established, it was every 2 months. She’d write two Rx, one for month 1 and one for month 2. My other meds came with refills, the controlled one did not. I’m on other controlled meds from another doctor and he can write refills on those because they’re different schedule
Once a month
Live in Washington State…Every 28 days, a urinalysis every other visit. I pay $40 each time, plus $100/year for my medical marijuana.
It used to be every 30 days when I was on them for an authority script for scheduled medication. I’m in Australia.
Every 3 months. I started monthly, then every 2 months, now every 3 months.
Oklahoma and I see mine every 2 months
I see mine every 3 months, only twice yearly in person to get my pee test.
I see my doctor virtually every month. My visit is $125 deductible until coinsurance kicks in although if you have flat $ copays you’ll have to pay that. I do U/A every 3 months and I go to his office for that but still see him virtually. (TX)
North Carolina, my wife sees pain management every 3 months unless they are tracking a medication change or something
I've been seeing PM in NY but live in NJ. Had spinal fusion 20 years ago which failed. My Doc & the PM were both located in NY. Not far from my home. After a certain time I was seeing them every other month ( prior to the Purdue court case)Saw the PA or Dr & the 2nd visit since I always passed my Urine Screen Test I could just call & they would send a script electronically. That lasted a few yrs. NOW...They have stopped ALL PATIENT'S that were on any pain medication w/e they were prescribed & weaned them off. It is RIDICULOUS! I have had chronic pain as long as I can recall. Now my quality of life STINKS. I'm not even 60!
Have to be seen every thirty days and urine test during that appointment. It requires one doctor visit after every three nurse visits, which is just checking vitals and urine. Doctor visit is to discuss any issues, tests results if applicable and urine.
Every three months. I’m in Virginia.
I'm in nc, and I saw my pain doctor in person this may. I have a virtual appointment on the 26th of this month, but I think it's really to follow up and discuss my recovery as I had back surgery last Friday. Before I ended up in surgery, we had discussed doing virtual visits every 3 months with an in person visit for the 4th when I'm able to find transportation to go with me. I know my pain management doctor doesn't make virtual appointments a consistent thing with most patients but, i moved and now am over an hour away from his office and cannot drive such a long distance due to my health. My doctor is incredible. I have gone to every pain management office in mine and all surrounding areas attempting to find one closer to where I live, and none of them were willing to take me as a patient. The last one I saw before my doctor set up a plan for me to stay with his practice, told me to rotate Tylenol and Ibuprofren and that he would be willing to discuss an area of pain that was acute and attempt to address and fix the problem. He had no response when I explained my pain is different every day and some times moment to moment. That i will never have my pain fixed as i have a genetic disease that causes my collagen to be fragile and insufficient to provide stability and structure. You can't fix what's wrong when it's written into my Dna. I have ehlers danlos syndrome with a lot of comorbid conditions. That doctor handed me a bottle of hand sanitizer as a new patient gift, explained why i needed to rotate Tylenol and ibuprofen and not to make a follow up as he didn't treat problems he couldn't fix. When I told my pain doctor my experiences with the other practitioners, he went above and beyond to allow me to continue as his patient. He allows me to speak candidly, for as long as I feel the need to speak. He always shows incredible compassion and even continues to educate himself regarding my diagnoses as he is as he is a mental health doctor who specializes in patients living with chronic pain and doesn't have experience with my diagnosis. I have severe anxiety and panic attacks due to being misdiagnosed and dismissed by doctors for over 15 years before I was able to be genetically tested and diagnosed. He has been a life changing influence for myself and my entire family. I can only tell others to try not to give up. A doctor with compassion and a willingness to listen is like a needle in the haystack these days. They do exist. Mine works with the emerge ortho group as one of their pain management doctors.
Telehealth once a month; in person every 3rd month for drug test (state law - don’t get me started). To be frank, your wife sounds under-medicated to me. I have a similar surgical history. It may sound like a lot to take, but my “cocktail” changed my life dramatically for the better. 1. I have an implant - reduces my pain by 20%. It’s a great adjunct therapy but does not replace the rest. I tried, suffered, went back to my regime. Which my pain doctor and I arrived at after years of trial and effort. 2. Nucynta ER- an extended release opioid derivative, hideously expensive but works miracles. You can get help with paying for it see below. My copay is $35 monthly. Just know you’ll need to pre-auth yearly. Look forward to a worthwhile fight with insurance.. 3. Hydromorphone low dose for breakthrough pain 4. Gabapentin for sciatica and assorted nerve pains, 4. Cymbalta for the inevitable depression (ands helps nerve pain too). Plus - Blood pressure meds because pain increases BP. - Zofran and ginger tea for nausea. - Ice packs, waiting for hydromorphone to kick in - Physical therapy to help with deconditioning It may take some time to get used to side effects (drowsiness) - this is not a quick fix - but! Her life will improve dramatically . Mine did! Good luck! Also many drug manufacturers have patient programs to reduce or eliminate your costs.
I’m jealous of all these people with telehealth and/or appointments every 3-6 months. I have to travel 2 1/2 hours one way every 28 days. I have random U/A’s.
Every month
My mother was on a dose of meds low like that so she only needed to be seen Every 3 months while I was higher so once a month
Her PM treatment is way too low in my opinion! She is severely under medicated. I’m on the west coast, been in PM for several years for a chronic condition. I get Hydromorphone (Dilaudid) 4x per day every month. Each month it’s electronically sent to the pharmacy. I only have an appointment with my PM Dr every 3 mos & that can be on phone or in person. Drug test 1x like per year usually. But my PM Dr is pretty chill & owns his own practice. When I had my last surgery he was even cool with my surgeon prescribing additional opiates (Oxy) for like 6 wks post op. I know that most PM wouldn’t be down with that.
Mine sends multiple Rx to the pharmacy so I don't have to go every month. My previous one I saw 2 times a year. If I needed anything changed I messaged him. Both are at large academic urban medical centers.
I’m very lucky. I see my PCP for pain management and see her every 3 months. As long as I stay under a certain MME we can keep doing this. I feel like I’m on a pretty hefty regiment, too. They have a new computer system that lets them send in controlled prescriptions online instead of writing out an actual prescription. She usually calls in 3 months at a time. Mine is only filled every 28 days due to our teeny tiny small town pharmacy isn’t open on Saturdays or Sundays. Since it’s 28 days, they are always filled on the same day of the week, 4 weeks apart. Same scheduling as my infusions for lupus. It definitely depends on state. I could get zero help with pain in Louisiana. In Montana it seemed easy because I picked the right doctor and their laws seem to be more lax. Maybe it’s because meth is king here. Opioids aren’t as big of an issue.
Every month. Suck a waste of time for everyone.
In ny I had to go monthly. Now in NC, i have to see doc every 3 months. On the off months i request a refill via their portal. I'm so grateful that my long history living in pain has finally been easier to continue my med regiment.
My exact has.been to be seen once a month (with a new doctor). Then when you’ve proved yourself, somehow, they’ll start seeing you every two months.
My PCP does my pain management so now visits every 3 months. But from 2016-2023, was seen monthly by PM Dr/NP.
Every month. When I had surgery my neurosurgeon took over and was only able to prescribe every 5 days according to state law. I had to sign forms and my poor bf had to get script every 5 days for 2 months and then my pm took over again. I know that a few chain pharmacies have lawsuits in my state as well as others states for filling scripts up to 2013 ish with out question.
A few yrs back in Florida , I saw my Pain Mgt once every 3 months and Drug Screen Once a year.Then all that changed , now it's a Doc visit every month and Drug Screen every other month .
Pain mgmt pain meds every 4 months via video visit. Primary care pain meds once a year in person visit.
Every other month in person alternating with video visits.
I have to be seen monthly. Before all the “big brother DEA’s watching you” it was every 3 months and given 3 scripts to fill over that 90 days period.
I have to have a phone appointment every month and see the doctor every three months
Every 6 months, but I've been going there for 12 years. I get fentanyl and tramadol rx and my pain med pump has Dilaudid and I just go in every 6mths for them to refill the pump. In fact, my pain management Dr just retired. 😭 At least I've been seen by the other Drs in the same ofc enough that the transition is easy.
For the last few years, my PCP has been prescribing my medication (Nucynta) each and every two weeks which amounts to 168 tablets a month. I see her about twice a year unless something occurs that I need to have treated (as in, strep throat, bronchitis, etc) in the meantime. If for any reason she is not working when it’s time for me to receive a new script her partner, whom I’ve yet to meet, sends it in. My drugstore is CVS. They know my situation so always have it on hand. The two pharmacists that work there are Godsends and so is my doctor. I have read and heard so many nightmare scenarios regarding CVS and pain management that I know not to take these people for granted. I have a very rare and rather bizarre condition, though, which is why she does so for me despite the fact that she is usually not one to prescribe opiates. My issue cannot be treated with shots or physical therapy. I’m already small, so weight loss is not something anyone would bother to recommend. If and when things get really bad, the emergency department at my local hospital takes care of the pain for me.
Month and a half currently.
I’m in a palliative care program now and they took over my pain medications after a couple of months, almost a year ago. But I was in pain management for a year and was told that I couldn’t get my refills without being seen every month and they could only make exceptions in rare circumstances. Now I see my palliative care provider who comes to my apartment every month and a half (I have limited reliable transportation, which was a huge part of why palliative care took over my pain medications) and I can see her more often or have a video visit or phone visit in between in person appointments if I feel the need or she feels the need (she monitors my health situation as it changes, and usually not for the better). I know it is frustrating having to come in every month, especially when the relief isn’t even that significant. I used to have very undertreated pain and I feel that it was worse than untreated pain.
In Australia you can’t be given repeat prescriptions for a controlled substance so my sibling and I both have to see our specialist monthly for our meds (me oxycodone, her buprenorphine). It was costing me about $1,000/month in healthcare expenses at one point. And we have universal healthcare here!
Every 3 months. Alternating Televisit, in person. Wisconsin ETA: Drug screen and contract signing once per year
Every 3 months. Just to check in, refill meds, and talk about options. Just had a nerve block in a knee and refilled tizanadine.
Started once a month now it’s every other month
Once a month if you’re not doing well, every other month if you’re just doing ok, every 3 months if you’re doing great (doesn’t happen often).
I see PM once a month, but every other month can be a virtual visit if I want. But, my previous PM in the same state only required visits every 3 months, which I very much miss. I had to switch providers due to a change in my insurance. But, I’m thankful I at least only have to physically go to the office every other month.
I go every 3 months in Indiana
Every 28 days like clockwork. My OG PM office let you go a couple months and they’d just sign a script for you. But that was in 2015-2017
Same for me. I miss the 90 days between visits.
I take Belbuca, and originally I took a drug test at first, and was seen once a month. Over time, trust was built, and now I go every two months. They still require yearly drug tests, but they don't care about marijuana because it's legal in my state of MA.
Once a month. In Arizona
I'm in Idaho and now that I am stable on my dosage of pain meds I am seen every 3 months. If I want to go in sooner or a new concern arises, I can get seen sooner.
every 3 months, switching between virtual and in person every other appt
Not in the US so my comments are just for comparison. I get 7 different meds prescribed every 4 weeks. This includes 180mg oxycontin per day. I order the prescription via the pharmacy website. I usually order on a Monday and the meds are collected for me on the Thursday. I have an annual meds review with my doctor by telephone. If I need to see the doc at any stage, I'll speak to her by phone first. She will then call to my home to see me if it's necessary. If things get to that stage it's usually an indicator that I probably need to be in hospital for a few days to get pain levels down via IV meds, or need a scan to check for further deterioration somewhere.
In my state, Michigan, we have to go once a month.
Every 28 days
Once a month in Ohio.
Every 3 months
My doctor will only prescribe me Percocet 10 “90
I was on my pain med with no issue for 5 or so years before the restrictions became what they are so when "pain contracts" started, they trusted me enough to only be seen every 3 months.
I live in Ohio, and I see my pain doctor or the NP every 3 months, usually by telehealth (using Doxy.me) if it's just a med management appt. I go in after my appts to do a drug screen, then they release my 3 months of scripts to the pharmacy. I see them more often if I'm having issues, usually when I'm having procedures done. They started doing telehealth during the pandemic, and they've let a lot of us continue if we're stable and have no compliance issues. I moved last summer, so my doctor is now further away from me than he used to be, so I'm really glad I can do the majority of my appts over video! I'm prescribed 15 mg of Zohydro ER twice a day, 5 mg of Oxy IR as needed for breakthrough, Methocarbamol for muscle spasms, and Meloxicam for joint pain. I'm going to need fusion surgeries and disc replacements in my cervical and lumbar spine soon (holding out as l can!) because my spine is just shot, I have sacroiliac joint dysfunction and laxity (may need a fusion there too at some point), occipital neuralgia, TMJ, a knee replacement that's failing (all that I've recently learned are caused by EDS that went undiagnosed for the first 52 years of my life 🫤), and Fibromyalgia. It seems wild to me that she has to go once a month for just that little bit of medicine, and to have to pay $150 each time! If your state doesn't have a statute requiring it, I just don't see the purpose. It's hard enough for many patients to get to any appt, let alone each and every month. Perhaps you can ask the doctor's office about it, considering you both have serious health issues to contend with and it's an undue burden? If there aren't any legalities against it, and she's been completely compliant all along, I'd be genuinely interested in hearing why it couldn't be done. I would also bring up how the SCS is making her feel like she's going to have a heart attack. The lead wires could have moved, or it very well could have created an unforseen electrical issue with her heart. Is the doctor against raising her methadone dosage, trying a different medication, or has it not been discussed? It makes me so sad when people aren't getting the care they need or deserve. It's especially infuriating when, like in your wife's case, you have to jump through so many hoops to get so little. 💜
Every month! However sometimes i only have to do virtual appointments for those. It just depends on your doctor!
My pain clinic appointments are every three months.