The lure of narcotic prescription drugs has created a new category of patient: People who lie about pain.
If they don't lie about pain, they offer stories about how their prescription spilled into the toilet or mysteriously disappeared.
If the stories don't work, prescription drug abusers may try almost anything else to scam a doctor, from hoarding pills to cheating on urine tests.
"Patients don't walk into a cardiologist's office and lie about chest pain. But people lie to me about pain all the time," said Dr. Paul Updike, a pain management specialist who serves as director of chemical dependency at Sisters Hospital.
And they have gotten increasingly sophisticated in their approach, Dr. Eugene Gosy, who runs a pain center in Amherst, said of drug-seeking patients.
"There are staged house fires and staged break-ins in which patients say their medications were destroyed or stolen. Patients will even present us with the police reports to 'prove' that these events occurred," he said.
The problem centers around patients seeking oxycodone, hydrocodone and other opioids to abuse or sell.
"It's easier said than done to treat people for pain in a way that detects the scammers, avoids addiction and ensures those who need pain management get it," said Updike.
The problem is made worse by the inadequate training many doctors receive in pain management and addiction treatment.
"Some people will always get through the system. The patients who try to scam you are good at it, and we are not trained to be police officers," said Ellen Battista, director of Pain Treatment Consultants of Western New York.
But she and other experts, including Updike and Dr. David Bagnall, director of the Spine Center of Niagara, say physicians can take simple steps to minimize problems similar in concept to the universal precautions used to prevent the spread of infectious disease.
The recommendations include using opioid treatment agreements with patients, screening for patients at high risk of addiction, using random urine tests and pill counts to ensure patients are taking medications and tracking patients' progress.
They advised trying nondrug treatments, such as exercise or behavioral therapy, before turning to powerful narcotics. They also called for treatment plans that seek improved function, which can be measured, and not the elusive goal of making someone pain-free.
"We use protocols to treat patients with such diseases as diabetes," said Bagnall. "Doctors need to apply a similar approach to pain patients."