Help, I'm in a bind - Pain Management Message Board

thomason · 06-15-2004, 12:39 PM

I've been reading this board for awhile, and am very impressed by the help / advice given on here.

Here is the situation. I had a serious injury in which I broke several bones and had hardware installed. I waited a year and the pain never went away in my leg, so I decided to have the hardware taken out. After that surgery was performed less than 3 months ago, I'm am still in extreme pain, and feel its probably going to be with me for awhile. I have been on and off opiates for pain since the original injury and have no problem stopping other than a few days of aggrevation. The fact that having to take this type of medication is irritating because of all the trouble the doctors have in prescribing it. I never ask for early refills, or do anything like having several doctors treating me at once. This brings me to my situation.

Within the last three months , following the surgery, the doctor that did the surgery was prescribing vicodin. He urged me to stop taking it, and reduced me down to 2 5/500's per day. I was struggling at that low of a dose for probably over a month. I was trying to come up with a better solution to get the meds that work for me, and take less of the liver and kidney damaging additives like tylenol and ibuprofen. The last time I called the surgeon he prescribed me darvocet, and that was it. It didn't do anything for pain. So I made an appointment to see my family doc, in which I described my situation and he gave me Lortab 10/325 which I took about 3-4 / day. I have no trouble tolerating it, and in fact that is really too low for my needs. But, the family doc said he couldn't prescribe anymore and he referred me to a PM doc. At about the same time, I learned from a friend, that his PM doc is one that is willing to do opiates. So I made an appointment with that guy and saw him today. I had also made an appointment with the PM doc that my family doc recommended, because thats the only way he would be willing to fill a script for the lortab. Anyway I saw the friend of mines PM doc today, and he said that he would need ALL of my medical records before he could treat me with narcotics, no way around it. I wasn't expecting that and getting the records will take several days. Meanwhile the other PM doc, who I have no idea how he is about prescribing, appointment is set for day after tomorrow.

Now this is where I don't want to screw up. I felt if I get the medical records for the PM doc I saw today, he is going to see that my family doc referred me to another PM doc, which I haven't seen yet but am supposed to.

I don't want this PM doc that I saw today to refuse treatment because he saw that I was supposed to go to another PM doc referred to by my family doc. I am not sure if that is grounds for refusal, or what the term doctor shopping might mean if thats what this could be considered. But I have not seen the other PM doc yet, and I'm not being prescribed anything currently by anyone. The last script was from my family doc for lortab, and he says no more until I go see that PM doc.

Anyway, I'm sorry for the long explanation, but I am really concerned about this. I don't want to do the wrong thing, I just want the meds for my condition. I feel that if I go to the PM doc my family doc referred me to, there is a chance he won't give me opiates. And I feel, if I don't go to him this PM doc I saw today will think I'm doctor shopping.

Please, can someone give me an opinion. I have to go get the medical records from all my previous treating doctors for this PM doc, and then he said after he checks it all out and makes sure I'm not doctor shopping or getting meds from more than one doctor, he can go ahead and start treating me. I don't know if he plans to call my family docs office, but if he does, I'm sure the family doc will tell him that I was referred to a different PM doc and even made an appointment with them.

So with all that, what is the thing to do here. Am I over-reacting? I am out of meds and going to be miserable, and on top of that I don't want to go through all this trouble if I'm just going to be refused treatment. If I get all the records for the PM doc I saw today, and he checks them out, I just hope that having made the appointment with the PM doc, referred to me by my family doc isn't going to interfere with this doctor treating me.

Thank you all for your time. I am not having a good day today. I hope someone can help me clear up this mess.

I wish you all well, and hang in there. Shoreline, your posts are extremely helpful , you are an asset to this board. I hope your adjusting to you pump well. I am amazed at the amount of help that is given on here, so I think someone will be able to give me some advice.

Shoreline · 06-15-2004, 01:53 PM

Hi Tom, I would go to the PM doc that your GP recomended, At this moment, You have not doc shopped, meaning you haven't recieved the same meds from multi0ple docs at the same time. It may be that the PM doc your GP wants you to see will be willing to help with your post op pain. Surgeons are notorious for ending pain meds when they see fit, Not when you say the pain s improving. At this point, I would be looking for pain control to rehab the leg, lack of pain control will prevent you from working the leg hard for fear of having unmanageable pain afterwards. 3 months isn't a long time post op. The wholes from the screws are strting to fill in, your have adhesions from the incision that need to be broken free so asking for the best rehab PT and help manageing the pain as you rehab is a reasonable request.

The first doc you saw, may be very willing to prescribe long acting meds, There will always be that alternative should you not fully recover.

You wouldn't be able to get the records PM doc #1 is asking for and then get a script within 2 days anyway. So seeing this doc and seeing what modalities to mange your pain he has to offer may be the quickest way to obtain pain relief and get on the road to recovery. I know you've been in pain long enough to call it chronic but with multiple surgerries your also a recovering surgical patient, and 3 months isn't tha long although surgeons usually cut you off by that point once they believe they have fixed you.

If you see PM doc 2 and he is willing to manage your pain, prescribe the PT and therapy to rehab the leg, this concern may be for not. Honsestly, Even If I gave you the name of my doc and you lived next store, you couldn't get in for several months , he would ask for the same info and eventually go through the steps of finding what works. The PM doc your GP recomends can literally start that day, he has a relationship with your GP, can obtain your records and do his job.Prescribe meds and start you in PT or change the type of PT your doing, Scar management is extremely important, more important than simple strength building.

The big question would be did you sign releases for PM 1 to start rounding up your records, It would look a little funny to have 2 PM docs rounding your records up at the same time.

If it so happens that PM doc 2 doesn't use opiates and you don't click, that's reason enough. You don't have to see a doc you think is a jerk, Personalities can clash for any reason. If you see him and things don't look hopeful, than go back to your GP and explain you have a personal recomendation from a patient and you would like to see the doc your friend sees.
I do want to thank everyone for the support and extreme kindness during these last couple of weeks. I had my pump increased today and when I told tmy PM doc that was given nothing for Post op pain from the surgeon, Since I was seeing him an hour later they told me to ask him to manage the post surgical pain. On the back of every script from my PM IT says If you have a surgical or dental procedure , do not use your chronic pain medication to manage this pain, obtain pain meds from the treating physician. It seems my PM doc is trying to get most foks down to 60 unit doses of BT meds per month and that woudoesn't last long for post surgical pain. SO I did ask, and he gave me 60 10mg Percecet. I didn't want to ask when I left the hospital just to maintain my smooth flight under the radar , but it only hurt myself. I should have explained where I was in my 30 day cycle and had no extra meds for post op pain.
Good luck, Dave

thomason · 06-15-2004, 02:20 PM

Hey Shoreline,

Thanks for the tips. Your idea of how to go about this is probably what I should have done, but I made a decision about an hour ago and hopefully it will be ok. Since I went to PM #1 today, and did sign some forms and started the process I feel it would probably be best to give it a shot. I do agree, now that you mention it that PM #2 would have been able to treat without delay and thats something I didn't think about, oh well.

I spoke with the previous doctors offices and if all goes well they will have my records ready to be picked up by this thursday. I'll drop them off with PM #1 on thurs and my appt is scheduled for friday. I asked him if I could just drop the records off the day before my appt, and it seemed that would be ok.

I decided to call PM #2 and cancel my appt. That way if PM #1 decides to call , he will see that I did cancel the appt. So I don't see any reason for PM #1 to not go ahead and start my treatment on Friday if all goes well. When I drop off the records on Thurs, I'll make sure that my appt the following day won't be too soon for him to find out what he needs.

I know it might be a bit longer of a delay with PM #1 , but since I went to him today, its like I already made my choice and I should at least give it till Friday. If things don't work out by early next week, then I'll just have to call PM #2 back and get in there.

I appreciate your help. I can understand how these doctors have to be careful about just prescribing to someone they know nothing about, someone just walking in off the street, so I'm not too upset about it. I just hope it moves along and there aren't any more unexpected delays.

As far as the holes filling in, your right about that. I can feel the bumps over them. They removed the rod from the knee, and I've had quite alot of pain in the knee as well. I know I'll never be pain-free, but I'd like to do things to get as close as I can to it. I did almost 3 months of PT, and didn't see alot of improvement other than a decrease in swelling.

Oh, and I don't know if I made this clear or not. The original injuries are almost 2 years old. The last surgery, which was about 3 months ago was remove the hardware in hopes to get the pain to come down. I don't know how long I'll be in this much pain, but the past 2 years have been really tough. I'd like to think that maybe in another year the pain will go down, but at this point I don't know if it will or not. The PT was stopped recently, after about 3 days/wk x 8 weeks to see if taking it easy will allow for it to heal.

feelbad · 06-16-2004, 06:43 AM

please do not take this the wrong way,but after reading your posts, I just have to ask you this.Are you looking at really trying to find the doc that offers the best pain control options or one that will just Rx you narcotics?i know that you have very legitimate pain issues,and it sounds like you are really truely suffering with this,but if you read your posts, you never mention trying to find the best pain control,only looking for who will Rx you opiates.Have you ever thought about this?addiction to narcotics is a very real possibility when having chronic pain in your life.Believe me, i know of which i speak.we walk a very fine line here with having to use narcotics just to get out of bed some days,and have to be always on the watch for any signs that we have become addicted to the very thing that keeps us going.I fell into this trap and i also suffer from some very excruciating pain.i just don't want to see this happen to someone else.

Believe me, i am not trying to second guess you or make you feel bad, i am only trying to convey what i read from your posts.i just thought that this needed to be pointed out to you.I truely mean nothing by it other than just being something that you maybe want to think about if you haven't already.I really hope that things work out for you thomason.Good luck and take care, marcia

Shoreline · 06-16-2004, 07:12 AM

Hey Thom, What you did seems like a perfectly legal response, Docs can make referrals to their buds, but it doesn't mean you are bound to only use the doc your GP likes.

The thing about PT is that there are so many different techniques an modalities and not a PT out there that practices them all. After my last surgery I went through round after round of different PT, Water therapy progressed into the gym and stretching and e-stim and excercise, But the first year nobody adressed the scarring. IF you placed your hand aover the incision and tried to move the skin, the skin was bound by adhesion to the fascia layer, so this became the priority of the nest PYT I saw, and seeemed to help the most by breaking up the scar tissue and adhesions and using myofacial release techniques. Being prescribed PT doesn't neccesarrily mean you will recieve the right PT.

Often like PM, PT's try to hammer every peg through the same hole, thinking that the technique they use will help anyone and everyone but may not adress specific issues another PT may find very important to address.

I;m sure you have insurance that has to aprove the PT and most have limits, want to see improvement and eventually claim you have reached maximum medical benefit and deny any further PT sesions unless you are able to pay out of pocket for neded PT.

You just want to make sure you recieved all the right and neccessarry PT that would benefit you the most.
Your PM can also prescribe additional PT, It may be an insurance battle, But if he can see something like scar management was never adressed tt may be cause for your insurance company to give you a few more vits.

A good PM doc is going to have more than one method to manage pain, obviously everyones pain and med neeeds are not the same. When it comes to PM I think of the bell curve we are graded by in HS and college. Some people on the far left of the slope may need minimal meds, or weaker meds and improve greatly from simple PT and meds like Ultram. The the center of the curve is where the bulk of people fall, they require a liitle more agressive pain management, more meds and more interventional procedures and the far right are people that have not responded to other attempts and are the higher dose patients, they may require mixed opiates, they may require more invasive therapy like nerve ablation or the pump or scs.

Everyone is different and you fall somewhere in the bell curve. Hopefully PM doc 1 is skilled and able to help folks on all locations of that bell curve. Yu really do want a doc that has more talent than the abilty to write a script, any doc can write a script, but rehabing a patient that became one of that 10% that the surgery wasn't succesful on, or needed hardware removed and more extensive pain intervention

Good luck, Dave
Sorry bout the spelling errors, I look at my fingers, not the screen. I just type faster that way but often mis some of my own errors.LOL