Senior Veteran (male)
Join Date: Jun 2003
Re: First Pain Specialist Consult
HI Counselor, What you loking for is a multifaceted aproach to pain management, A combination of meds, modalities and interventional procedures.
I would make a list of all the methods you have tried already, the what, who where , when and doctor that treated you along with contact info.
The reason is, If you have already had 3 epidural steroid injections or a number of steroids injection into a joint he needs to know when , and who did them. There is a limit to how many ESI they can give in a year. There are limits to how many medrol dose packs you should use or how much oral steroids you consume in order to prevent problems from the treatment itself. Without knowing what you pain generator is it's hard to be specific.
I did go through about 7 years of non opiate pain mnagement and 3 major back surgerries before finding what worked for me. Many PM docs wouldn't prescribe a tylenol 3 for pain, some docs are very loose with medication, especially when they have nothing else to offer as far as treatment options, Some docs use opiates as a last resort when everything else has been tried or failed.
Things I tried or learned prior to finding a doc willing to treat 3 failed back surgerries with opiates were things like months and round after round of PT, all PT is not the same, There is scar management, there is myofacial release, some PT's do chiropractic type adjustments, some do trigger point therapy, some do work hardening and strength hardening. . There are plenty of psych techniques and learning that chronic pain, or the pain you feel now is no longer a warning sign that something needs to be done imediately.
If a CP patient went to the ER every time they had an increase in pain it wouldn't take long to get labeled a drug seeker. So I and all the other pateints in the 3 PM clinics I attended, included eduction about chronic pain, learning methods like Bio feedback, self hypnosis, guided imagry, yoga or whatever relaxation therapy the clinic uses. I learned each method at a different clinic. That's part of the reason for making a list of what you tried. I also have tried, Chiroratic with several different chiro's, acupuncture with several different practicioners, had a tens unit, I had TINS performed, "deep muscle stimulation"
THere All types of steroid injection, trigger point injections, nerve blocks, nerve destruction either chemically or Radio frequency.
Basically if you are seeing a doc in practice by himself, you need to find out what he has to offer. If all he has to offer is a script pad, and his only interventional procedure he nelieves in is Trigger point injections or ESI's. You may benefit from another modality. But it doesn't make sense to go right to instant relief from opiates and all the negatives of using these meds, if something simple like an antidepressant, a muscle relaxer and acupuncture would work. It's just trial and error untill you find what workls for you. Basicaly what I mean is why start with something like Oxycontin if something as simple as Ultram and PT would do the trick. He may not be the right doc.
I know in reading these forums it seems like long acting pain meds may be the standard choice to treat intractable chronic pain, but very few of us were offered this type of pain management at the first consult without trying dozens of other methods. It's simply a matter of trial and error. Expecting imediate relief and total relief isn't realistic. You may jumjp through a dozens non opiate modalites and see 8 PM docs before you find what's right for you.
But bypassing all the other modalities and going for the quick fix with long acting opiates like Oxycontin or MSContin or duragesic patches doesn't make sense and would be hard for a doc to defend his prescribing if he hasn't documented any other method and it's falure to manage your pain. It can be a long process and be disapointing waiting 2 months for an apt and then finding all they have to offer is acupuncture which you may have already tried 2 or 3 times unsucessfully.
If the doc has only one trick in his bag aside from scripts for meds, YOu my need to try seeing several docs to find what works for you. Yes opiates relieve pain, but why start with opiates, dependnecy and all the negative aspects of opiates if something simpler would do the trick. Many docs use antidepressants, anti seizure meds, specific receptor blockers like Nemanda which is a potent NMDA receptor blocker used to control tolerance, threshold to pain, duration of meds and this receptor seems to have alot to do with neuropathic pain.
There are medication infusions for spasm or spacticity like Robaxin infusion, There are meds and patches for topical nerve pain like Lidocaine infusion, Ketamine, or lidocaine patches along with compounded saves and creames to relieve topical nerve pain. Opiates are just one small part of what can be done and trying many other methods may be neccesarry. If the doc throws opiates and a pile of medications at you, although it may offer some instant relief, You may have skipped something much simpler that could have done the job. Good luck and do some investigating about this doc, Most have web sites that describe their education, philosophy and the modalities they use.
Good luck and welcome, Dave