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Old 04-07-2005, 03:50 PM   #1
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Having a Problem with Dr.'s Pain Management Plan and Need Advice...

Hi everyone,

I am new to the boards, but am at my wits end and don't know what to do. I have a grade 2 spondylolythesis at L5-S1 with accompanying right radicular pain. I live in a small town in northeast Kansas and have seen the one orthopedic group there is here. The pain in my back became constant last October and I was referred to said orthopedic group and finally got in to see them after 2.5 months. During those 2.5 months I was given nothing for pain management. Once I saw the Ortho Dr. I had hoped that would change, however things have not gone well. He started me out on 50-100 mg Tramadol q 4-6 hours along with Tylenol 1000 mg 4x per day and Ibuprofen 800 mg 3 times a day. I had a bad reaction to the Ultram in that it gave me bad headaches and didn't provide any pain relief. I informed the Ortho Dr. of this 2 weeks into seeing him and was told there was nothing else he could do for pain. I have had 3 ESI, 3 Peroneal Nerve Root Blocks, 5 months of physical therapy and no pain relief. I have repeatedly told the Ortho Dr. that my pain is at a level that is unbearable and he has contiued to state there is nothing else he can do. I know there are stronger pain medications but this guy just won't prescribe them. I have called my family Dr. about it and they told me to talk to the Ortho Dr. because they were handling my back now. I'm starting to feel like they are treating me like some drug addict and I haven't even had a potent narcotic pain medicine to relieve the pain!!! I don't know what to do insomuch as my family Dr. and the Ortho Dr. refuse to do anything and I can't tolerate the pain anymore. I have become extremely depressed and have been feeling desperate about the situation, which scares me. I need help from a Dr. who isn't afraid to do some actual pain management and won't look at me like a drug addicted quack job for asking for help in the first place. What should I do!!!???

 
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Old 04-07-2005, 05:20 PM   #2
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Re: Having a Problem with Dr.'s Pain Management Plan and Need Advice...

That is so wrong. I would DEMAND a narcotic pain pill. Its is their duty and your right not to go through uneeded pain.
My Doctor told me that it was his responsibilty to treat my pain no matter what it takes and a Doctor has to treat your pain. I'm serious, you tell those Doctors that they are making you needlisly suffer and you refuse to suffer anymore.
Stand up for yourself because no one else will.

 
Old 04-07-2005, 05:37 PM   #3
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Re: Having a Problem with Dr.'s Pain Management Plan and Need Advice...

Oh you poor person. I know the pain. You can Thank what's his name for that. Every since he admiited that he was addited to Vicodin. Doctors have een so scared to give anyone anything. That was all over the news. Now FDA has there hands in it. I had a doctor, that was giving me pain meds as needed. Then when all of this crab came on TV and in the newspaper, he made me go see a pain management doctor. That's what they are there for. They are the one's that can easily if everything has shown that you are in allot of pain than they should give you what you need. to bad you can't go to a Mayo Clinic. They would help you. I would suggest an Er room but they also are real strict on bad meds these days. I wish I could help. I'm here just to talk to if you need me. Please try not to give up.
Blueyedk

 
Old 04-09-2005, 12:44 AM   #4
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it never ends HB User
Re: Having a Problem with Dr.'s Pain Management Plan and Need Advice...

I keep hearing this story over and over. I made the same mistake you are making, and so many others make, so don't feel bad. But here is the answer: you need to find a pain management specialist or a pain management clinic. Orthopedic doctors do not want to give pain medicine. They want to fix your back. You need a PAIN doctor. There are different specialists for different things. Your back is sick with pain. It is also sick with whatever caused the pain. That is why you need two doctors. One for the back and one for the pain. I know that you live in a small town, but the drive will be worth it. After you find a pain doctor, and become an established patient, you will only need to see him once a month. I know people who drive for four hours to go to their pain clinic. That is because it is worth it. Search on the web or at the library for pain clinics, or pain doctors. Good luck.

Last edited by it never ends; 04-09-2005 at 12:50 AM.

 
Old 04-09-2005, 05:06 AM   #5
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Re: Having a Problem with Dr.'s Pain Management Plan and Need Advice...

Most family drs and OS and NS do not do pain mangement I'm very fortuante my GP does but that's rare as was said you need to find a PM dr and just because they specialize in PM does not mean they will write you scripts many just want to do ESI inj. ect, so it may take you a few to meet your needs.
Drs nowadays are in fear of the DEA and don't want the hassle.
Not to be argumentive but no dr has to prescribe you meds.I have been living with CP now for 6yrs and have meet more that won't then will, once you have surgery or whatever a dr does to take you as far as his treatments will he can release you and you are no longer his responsibilty, right or wrong it's the law.
I wish you the best of luck in finding a good dr to help their out there few and far between but don't give up there are the ones that believe we shouldn't have to live with CP and misery.
Linda

 
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Old 04-09-2005, 07:40 AM   #6
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Re: Having a Problem with Dr.'s Pain Management Plan and Need Advice...

Hey Mavs, Fan,

 
Old 04-09-2005, 01:30 PM   #7
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Re: Having a Problem with Dr.'s Pain Management Plan and Need Advice...

Quote:
Originally Posted by Shoreline
Hey Mavs, Fan,

Hey Shore, what happend to ya?

You okay? I have been trying to read your posts regarding your situation, and was just wondering how you were. So, if you come back to this post, I just want you to know, I'm thinking of you, and especially since it seemed like you started to post but then quit.

So, just giving you a "hey" and letting you know I'm wondering how you are.



Oh and STREETCAR! You too! Just wondering about you also since I haven't seen any posts from you in awhile. So if YOU read this thread, give me/us a holler.

And ANY of you who I "confer" with on a regular baisis. Hi, what's up? How are you? Miss you. etc etc etc.
misery, twisten, robin, streetcar, shoreline, surgical disaster, and anyone else I'm missing here.

What the heck was the topic? LOL

Oh! Pain Management! Yes, Yes Yes! Having my PCP refer me to a PM doc was the BEST thing that ever happened to me. I was dx'd with my inital back problems in Oct '02 by my PM doc. He was part of a big medical clinic with a bunch of departments, but now he is on his own, and he is just a blessing. His nurse is wonderful, I can call her and ask her things, she's very frank with me, about meds, different docs, and what's going on with my pain. He is very willing to work with me as far as any requests I have for meds, treatment, anything. I will be speaking to him this week about finally getting me operated on and hopefully things aren't so messed up back there, that I can get some relief. He will recommend the surgeon and I feel good about that. He has also agreed to continue to treat my pain from Fibromyalgia and Myofacsial Pain Syndrome, and Chronic Fatigue, so I know I will be in his care for a long time. I'm sure he'll out live me! But yes, try try try to get a referal to a PM doc. Some PM clinics are very complex in that they include PT, mental health, procedures as well as pain meds. Mine isn't like that, but he is very willing to refer you out to docs who can help. For instance, he is sending my records to a Physiatrist who specializes in all kinds of chronic pain. His nurse even told me about the doc I was asking to have my records sent to. She said that some people don't like his bedside mannor but he is an excellant doc, and if I didn't like him, she'd find another for me. Some clinics will have you sign contracts which means you get ALL your narcotics from them, and you may have to give urine specimens from time to time. Some docs have questioneirres that you fill out each visit. I think Shoreline's doc does that. Mine does not. Each is different, and yes, right now they all seem to be going through a little hassle with the DEA as far as the way they write their scripts for some meds, basically, you will have to see your PM doc every month for your refills. They aren't like you see them, get a script with 5 refills. You are monitored very closely.

See if your PCP will refer you. I don't think there is any other way to get into a PM office other than a doctor referal. Some insurance companies allow you to see any doc without a referal, mine does, but there are some docs who won't see you without a referal no matter what your insurance policy is. Like I can go to any rheumatologist I want without a referal, my insurance company doesn't require it, neither for mental health, I don't need a referal. But for PM or Infectious Disease or Physiatrists, you need a doctor's referal.

Well NOW I have certainly blabbed on and on when I simply could have said, I agree with the other posters, try to get into a PM doc. Sorry about that!

Good luck, and keep us posted on what's up, k?

tk

 
Old 04-09-2005, 02:50 PM   #8
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Re: Having a Problem with Dr.'s Pain Management Plan and Need Advice...

Thanks for the feedback everyone and here is a small update. I called my PCP about getting a PM referral and was told that anything related to my back goes through my ortho Dr. now. So, I called and asked my ortho Dr. to refer me to a PM and his nurse called back and said that the Dr. said he couldn't do that. I explained to her for about the 50th time that what they were doing wasn't helping and asked again that they please refer me and was again told no. The nearest town of any size to here is in Topeka Kansas. I was only able to find one pain management group there and called them to ask about getting an appointment. As most of you have said, they said they needed a referral. Since my primary care doc keeps telling me to talk to my ortho Dr. and my ortho Dr. keeps telling me he won't do anything and that he won't refer me to a PM, I am sort of at a dead end. I could try to find another primary care Dr., but there is only one major medical group here and all the primary Dr.'s I know of here are affiliated with that group. The entire system is electronic so if you go see one Dr. in the system they have everything from every other Dr. I called one of the other primary care Dr. and they asked why I wanted to leave my current primary care Dr. who is in the same group. I told them about my situation and they said that I needed to resolve that with my current Dr.'s and didn't give me an appointment. I swear this is like some bizarre nightmare that keeps getting worse. Kansas City is a 3 hour drive from here although I wouldn't mind going there. The problem is that I can't get a Dr. here to give me a referral. I will keep digging, but I am not confident anything will come of it.

Thanks again everyone for the feedback and I will keep you posted. If anyone knows a good PM clinic in the north Kansas area I will try anything, but this is starting to get ridiculous.

 
Old 04-09-2005, 03:01 PM   #9
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Re: Having a Problem with Dr.'s Pain Management Plan and Need Advice...

Have you tried telling your PCP exactly what the problems is and your ortho won't refer you, sorry I'm sure you have, I just know if not got my GP I would not have made it these yrs. another thing is you might try checking with your ins. if you have a network and find out what PM's they have and just try calling and maybe you will find one that doesn't require a referel.
I wish you the best of luck I know how important it is to have pain management.
Linda

 
Old 04-10-2005, 02:43 AM   #10
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Re: Having a Problem with Dr.'s Pain Management Plan and Need Advice...

YIKES...Tylenol 1000 mg 4x per day and Ibuprofen 800 mg 3 times a day...my goodness this sounds like an ulcer waiting to happen! Before I went to pain management I was prescribed 800mg Ibu; along with percocet...doc didn't prescribe the ulcer that I got! Talked to the pharmacist and he insists that my ulcer was not caused by so much tylenol, he was emphatic about it. I agreed to disagree.

 
Old 04-10-2005, 07:46 AM   #11
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Re: Having a Problem with Dr.'s Pain Management Plan and Need Advice...

Mavsfan,

it burns me up to hear this same strory over and over.so many patients with confirmed dx still have problems getting adequate pain control.

i hope you seek another dr as there is help out there.this doc is full of it,ofcourse there is more he can do to bring the pain down to a level where you can function and get some quality of life back.

i have similar lumbar issues (instability) and multiple disc problems.i suffered for the first 8 months without adequate pain control.
when i finally was referred to a good pain mngt dr i remember how happy i was the pain finally started easing off with the help of meds.

i started working again and was able to spend time with my family rather then in bed with an ice pack.i started PT and after a few months of core stregnthening things improved dramatically.

you are taking too much tylenol.do what you have to.get to a pain dr.ask for a referral for injections if you have to.atleast youll see a different dr who may be compassionate enough to help.

hang in there,scott

 
Old 04-10-2005, 12:14 PM   #12
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Re: Having a Problem with Dr.'s Pain Management Plan and Need Advice...

Hi There,

I just wanted to say how sorry I am that you are going through this. I, too am suffering and finding it near impossible to get any relief from my pain. I was referred to a pain clinic, but still, they wont give me anything until I complete a process of physical therapy and behavioral counseling, and have sterold injections. The asenine part of this is that I have been jumping through all these hoops, but the last part I have to do before they will give me any narcotics or opiates is the behavioral counseling.

The counselor only works one day per week, so there is a 6 week waiting list to get an appointment. This is rediculous. When I read your post, I felt so bad for you.

Another thing to keep in mind, my previous doctor had me on a tylenol and advil regimine like you are, and it HAS done serious damage to my kidneys. The funny part for me is, I was at least receiving a little codiene before I went to the pain clinic, and now I'm not. They decided I was high risk (because of my psychatric condition). I hope you don't give up. I would try and get your primary doctor to refer you to a DIFFERENT orthopedic doctor, one who will either give you an rx, or send you to a pain clinic.

Good luck to you, hang in there!!!

~~heather~~

 
Old 04-12-2005, 11:24 PM   #13
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Re: Having a Problem with Dr.'s Pain Management Plan and Need Advice...

Hi again everyone and thank you for all the support. I have another update to share. I did some calling around and found a Pain Management Clinic in Kansas City that didn't require a doctor referral unless it was required for insurance. I called my insurance and they said that I didn't need a doctor referral for them to pay for a pain management specialist so long as he/she was in their network in my area. I got really depressed about that because I didn't think there was any PM in this part of Kansas.

However, I do have some good news to share. My wife did some calling around and found out there is a PM doctor right here in our town. It turns out that the anesthesiologist who had given me the peroneal nerve root blocks also has his own private pain management practice. I never knew because whenever the Ortho Dr. would order shots or whatever I would just go to the oupatient "surgicenter" and someone would give me the injection and I would go home. The only shots the PM did were the Nerve Root Blocks, so I just assumed he was another anesthesioligist that took his turn giving shots at the surgicenter. The great news about it is that my wife called their office today and spoke with the Dr.'s wife (she is the office manager of his practice I think) and told them the entire situation I am going through. My wife told me that the PM's wife was very understanding and told my wife on the phone that they knew who I was and that the PM would be happy to have me as a patient. So they set up an appointment for me to be evaluated by the PM on April 29th. Further, the PM's wife said that she would keep me in mind and if a cancellation happened or anything like that they would try to get me in sooner than the 29th because they understood I was in a great deal of pain. They said that they didn't need a referral from the Ortho Dr. since they had already given me those nerve root blocks. They also said that when I come to visit I can arrange it so that they are handling the day to day management of my pain problems and so that I don't have to go through the Ortho or PCP and can deal with them directly to manage my pain problems.

I have never been to a PM and my wife didn't really know what to expect, so she asked the PM's wife what they usually do for treatment and the PM's wife said that they use a lot of different things including various injections as well as pain medication. My wife also said that when she told them about my problems with Ultram that the PM's wife said not to worry because there are lots of pain medications they can use and they work with their patients to find the combination of medications and other treatments that is right for them. This is the first positive development I have had with my back in almost a year. I really appreciate all of your encouragement and advice. I had really thought after my experience with my PCP and Ortho that the Ortho was the gatekeeper to any hope I would have of seeing a PM and it turns out that being persistant has really paid off. An added side benefit is that my wife is actually smiling again because she feels like she was able to do something to help me. She has had to endure a lot of stress because of my problems and I think it was really cathartic for her to be able to do anything to help me with all the pain.

I will continue to update you all as things progress. I still have a long road to haul I think but for the first time since my pain began it looks like there might be a light at the end of the tunnel. I know there are no guarantees that I will get any pain relief from this PM when I see him, but being able to see a PM at all is a 100% better situation than the one I was in even a few days ago. God bless you all and I pray that you have a pain free day.

 
Old 04-13-2005, 04:40 AM   #14
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Re: Having a Problem with Dr.'s Pain Management Plan and Need Advice...

Great news it looks like you are going to be in good hands..
Looking foward to your update and may there be a cancelation so you can get in sooner..
Linda

 
Old 04-13-2005, 07:23 AM   #15
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Re: Having a Problem with Dr.'s Pain Management Plan and Need Advice...

AWESOME!! I am so happy for you!!! It took me 5 years to get any type of help also. It is an unreal feeling when someone actually WANTS to help with your pain!!

 
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