Yall need help. I hate to see docs have stress from pain patients. I'm an invasive and non-invasive pain doc. I hate the distinction b/c pain docs should do it all and not pick and choose.
Anyway, simple things I do that work, are legal, ethical, and the dea is happy with.
1. you do not have to prescribe narcotics if you think they are NOT the best for the patient. Would you prescribe a beta-blocker to a patient with a hr of 45 just b/c they want it.
2. Even for legitimate pain etiologies, if patients can not be compliant with clinic rules, can't keep their bill paid, keep scheduled appts, not run out of meds, not loose meds or Rxs, or fail random urine drug screens,then potent narcotic analgesics are not in their best health interest.
3. if patients don't get other treatments, studies, or other recommended modalities and just want pain meds, their pain is not driving their behavior, but their med seeking is.
4. I would not recommend actively firing a pt. If you do not prescribe the meds they want b/c you think them inappropriate, give them all the naprosyn they can carry only and they will fire themselves.
I'd be happy to answer any pain med questions.
