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Old 11-22-2010, 12:23 AM   #1
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Are Primary Care Docs Qualified for PM?

I've never been to a pain management Doctor, or Clinic. My PCP has been prescribing my Norco. Should I go to a Pain Management Doc instead? What advantages are there to that route?


 
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Old 11-22-2010, 09:46 PM   #2
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Re: Are Primary Care Docs Qualified for PM?

Since you didn't give your diagnosis, it's not really possible to even guess as to whether your PCP is the right doctor to be treating you OR if taking Norco is the best treatment for you. If you have a chronic pain condition and are concerned that your PCP may not be treating you optimally, I think a pain management physician may offer better treatment options. Most pain specialists have studied pain management in greater detail than PCPs, but whether that translates into better treatment depends on a lot of things. All things considered, I think pain physicians are likely to be more up-to-date with the rapidly changing world of pain management, and I wouldn't hesitate to suggest seeing a pain specialist for anyone dealing with chronic pain. I hope that helps answer your question.

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Originally Posted by Isotope View Post
I've never been to a pain management Doctor, or Clinic. My PCP has been prescribing my Norco. Should I go to a Pain Management Doc instead? What advantages are there to that route?


 
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Old 11-22-2010, 11:24 PM   #3
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Re: Are Primary Care Docs Qualified for PM?

No, my PCP is a bit out of his league, even concerning my GI issues. My dedicated GI Doc is too busy to give me time to blurt out even a few questions. He also thinks his patients are whiners (I suspect), so I rarely complain to him about pain.

My question, originally, was, how do PM Docs work? I read posts where people seem to be in trouble with their PM docs, or are drug tested, or have to follow some strict orders. Is this true?

 
Old 11-22-2010, 11:48 PM   #4
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Re: Are Primary Care Docs Qualified for PM?

Why are you only prescribed one tablet per day..... is there only one brief part of the day when you're in pain, you do you get 4 hours of relief, and have to just put up wit the pain the rest of the time?

If the latter, then a PM doc might be the way forward, but yes, there are going to be some quite strict conditions attached, from what I understand of American practice, random drug tests etc
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Old 11-23-2010, 12:29 AM   #5
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Re: Are Primary Care Docs Qualified for PM?

Isotope, Yes, it is true that most Pain Management Doctors in the U.S. will have a "contract" for you to read and sign before care is implemented. The usual rules are- unannounced or random drug tests(urine), getting all your controlled substances from him/her and no other doc, using one pharmacy only, your prescription activity will be monitored on many levels-hospital,pharmacys,PM and other docs can see what drugs you have filled, pill counts, etc. Being in PM is a priviledge, not a right. I also forgot monthly visits for every prescription until the PM doc has built up enough trust in you. However, there are those docs that forever ask their patients to come in monthly for scripts. So, there you have it. Surely, more people will chime in here....janiee

 
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Old 11-23-2010, 01:17 AM   #6
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Re: Are Primary Care Docs Qualified for PM?

My original script was just meant for break through pain, just a little help slowing the gut down was the intent. Codeine also has that effect.

My GI disease is post Ulcerative Colitis, and post surgery, called Pouchitis which is chronic inflammation of the reconstructed small bowel. Antibiotics and Prednisone are the standard treatments but it can progress to an extreme state that requires Immunomodulators, TNF Biologics, or Cyclosporin which is a very powerful and dangerous drug used in organ transplants and Chemo.

I've had these issues since the mid 1980's and only recently started looking into pain management, so I'm still learning about it.

My ideal drug therapy would be one that slows the gut, relaxes smooth muscle, reduces inflammation, reduces cramping and pain, and doesn't make me too anxious or too sleepy. If it also gave me a nice sense of well being, that would be a bonus. I also take Prozac (which I don't think is working anymore) and I also take an occasional Klonopin for my anxiety and social phobia.

One nice aspect of Norco is that I do tend to feel more relaxed and less anxiety ridden when I take it. Maybe that is where the 'Addiction' comes in.....

 
Old 11-24-2010, 06:25 AM   #7
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Re: Are Primary Care Docs Qualified for PM?

My primary care doctor can rx me oxycontin, percocet and whatever narcotic I think and of course the fentanyl patch, so he told me. So far I'm on 40mg oxycontin, I'm not sure he's allowed to rx me higher than that.

I didn't like the pm clinic. they didn't believe me I'm in pain. they told me I imagine it. It's all in my head, that's what the pm told me there. 90% is your pure imagination. I was full of tears. Go on with your life that's what I've heard. go to a psychologist. Unbelievable. They rx me there tramdol extended release which you can try by the way. But I've met there other people who suffer from pain tremendously. Chronic pain patients who gave up on life. They told me they're always on pain and that they gave up. You know what the pm there told me? he told me that fentanyl patch is equal to the percocet strengh. Now that I think of that. WHy did he lie to me?.

I have a good pcp, he told me he will rx me fentanyl patch if I want. It's pretty crazy. I told him, that now he's my chronic pain doctor. He looked at me in a strange way and didn't even respond. But that's what he is basically. pcp don't learn much about chronic pain in school. But now I believe they read about it in books etc. From some reasons he told me right away that I have chronic pain and that it's rare so I guess he knows about that something. Perhaps he studied about that. It's such a shame they don't teach pcp in medical school about that. My doctor and I'm sure every doctor knows chronic pain patient don't have any quality of LIFE.

so I don't need to do any contract etc or blood check for now.

isotope, I can't imagine what you're going through with this chronic pain and really sorry that you have to go through this path in life.

 
Old 11-24-2010, 09:58 AM   #8
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Angry Re: Are Primary Care Docs Qualified for PM?

I'm really very sorry and upset that you were not treated with respect. There are jerks in every field, and unfortunately, doctors are no exception. I too have seen my share of arrogant, obstinate, and pseudo-intellectual doctors accuse me of either making up my pain or not trying hard enough to deal with my pain. As a chronic pain sufferer for the last 32 of the 50 years I've been on this earth, I have had to deal with all sorts of health "professionals" who dismissed me as a malingerer and drug seeker. I got rid of them as soon as I could. Sometimes getting a third, fourth, fifth, (and so on) opinion is all you CAN do. It's frustrating to have a doctor disbelieve you, especially when you've had documented medical problems that are known to be painful, even post-treatment. The ability of most chronic pain sufferers to function and appear stoic even when in significant pain sometimes works against us. Many of us deal with severe pain on a daily basis (and for the truly lucky, we're constantly in pain, even if medications, other therapies, and our own resolve to remain calm helps reduce the suffering associated with the pain.)

It sounds like you need to see a different doctor, one who will treat you with compassion. Because I don't know where you live, I cannot give any particular recommendations to you (and this website frowns on doing so.) But if you are willing to tell me where you live, I'll ask the website moderators how to share information about resources close to you. I have a very good friend who works with pain doctors all over the United States and in many countries around the world, and I value her insights tremendously. You might also try Googling for "ASIPP" (the American Society of Interventional Pain Physician) to see if they have any recommendations. You may also want to consider talking to another gastroenterologist if your present one is out of his league.

I know how frustrating it can be, but all I can say is that you are your own best health advocate, and you have the right to be treated for your pain. Don't keep seeing ANY doctor who isn't willing to treat you with compassion. There are doctors out there who will welcome you as a member of your treatment team, and not treat you as a drug-seeking and weak-willed loser.

Consider bringing someone with you on your next doctor visit - someone who sees what you have to deal with and can help explain to your doctor that you are not imaging or exaggerating your symptoms. This is especially useful for people who have difficulty being their own advocate.

Please don't give up, and do let us know what's going on as things progress.

Jeff

Quote:
Originally Posted by nochange View Post
My primary care doctor can rx me oxycontin, percocet and whatever narcotic I think and of course the fentanyl patch, so he told me. So far I'm on 40mg oxycontin, I'm not sure he's allowed to rx me higher than that.

I didn't like the pm clinic. they didn't believe me I'm in pain. they told me I imagine it. It's all in my head, that's what the pm told me there. 90% is your pure imagination. I was full of tears. Go on with your life that's what I've heard. go to a psychologist. Unbelievable. They rx me there tramdol extended release which you can try by the way. But I've met there other people who suffer from pain tremendously. Chronic pain patients who gave up on life. They told me they're always on pain and that they gave up. You know what the pm there told me? he told me that fentanyl patch is equal to the percocet strengh. Now that I think of that. WHy did he lie to me?.

I have a good pcp, he told me he will rx me fentanyl patch if I want. It's pretty crazy. I told him, that now he's my chronic pain doctor. He looked at me in a strange way and didn't even respond. But that's what he is basically. pcp don't learn much about chronic pain in school. But now I believe they read about it in books etc. From some reasons he told me right away that I have chronic pain and that it's rare so I guess he knows about that something. Perhaps he studied about that. It's such a shame they don't teach pcp in medical school about that. My doctor and I'm sure every doctor knows chronic pain patient don't have any quality of LIFE.

so I don't need to do any contract etc or blood check for now.

isotope, I can't imagine what you're going through with this chronic pain and really sorry that you have to go through this path in life.

 
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