Doctor troubles! - Pain Management Message Board

pookeysmom · 03-13-2006, 11:56 AM

I was almost fired as a pain management patient today.

At my last appointment I told the nurse practitioner that I was having too much breakthrough pain and I was very tired, especially in the afternoon, he added lyrica and provigil to my medications. He also wanted me to taper of neurontin and cymbalta. I was given lower doses of the cymbalta but I had no details on the neurontin tapering.

I didn't really think of it at the time but I had started taking antidepressent a couple of years ago. (My primary care doctor thought that I was depressed and that was causing my pain, it was really the other way around.) The 2nd anniversary of my Moms death was coming up and after talking to my Rhuematologist we both agreed that it was not the time to stop the cymbalta. I called and left a message with the PM nurse (you can't talk to anyone at the office if you call- they will transfer you even if you insist on talking to someone) asking if it would be okay to keep taking the cymbalta and they never called back.

Two weeks later I realized that I was getting a migraine every weekend- not to much fun. They had told me before that they don't treat migraines, but I was concerned that talking 2 anti seizure meds at the same time might be causing the migraines- again I called and left a message and again no reply.

I did cancel the next appointment I had for an injection - because I had the flu! It was rescheduled for tomorrow. This morning I realized that I had gotten no response from the nurse and it was time to refill the neurontin again. I called to see if I could cancel the injection and make an appointment to get the medications straight first. (When I get the injections the Dr. doesn't come in until you are lying on you stomach half naked with surgical drapes, I find it difficult to ask questions while he is inserting a needle into my spinal column - is it just me?) The new receptionist put me on hold and when she came back she said the if I don't come in for the injection tomorrow there is nothing else they can do for me. I was in shock, I asked who had said this and they said it was my nurse practitioner. I am currently talking multiple meds including pain medication that they prescribed. Can they really do that? I told them that I would come in for the injection as long as I could talk to the Doctor. I am afraid that the only time that I will have to talk to him is during the injection.

There have been multiple other times when the office staff has been rude and they had made billing mistakes. I am so afraid that I won't be able to find someone else, but I don't think that I am being treated the way I should be. Am I just being over sensitive?

conductor · 03-13-2006, 05:30 PM

Dear pookeysmom,

Concerning the "Can they do that?" question, it is probable that they can find what they consider a "breach" of your contract. Certainly, I am not saying that they are right--I'm just saying that they could probably interpret just about any clause contained in the contract against anything you have supposedly done. Even cancelling an appointment could be construed that way--if they wish.

When these people don't respond to messages concerning your medications, this is a serious cause of concern! Furthermore, what on earth do they mean when they say, "We don't treat migraines"? Migraine headaches (the truly diagnosed ones) are as much of a pain issue as anything else. While I understand that a neurologist might be another option for migraine treatment or recommendations, I would think a PM doctor would want to be aware and an active part of your entire pain treatment.

This is only my suggestion, but get your doctor's attention during this injection time. If you are able to grab him by the lapels--do it. I guess I'm kidding on that one, but my Mother actually did that for me one time when I was in the ER for an extremely bad migraine headache. Frankly, it got the job done quickly.

It has been my experience that the messages you state do not make it to the doctor in the same manner you give it. Speak to this physician kindly, but frankly.

Someone needs to evaluate your medications! Perhaps some other readers can help you. Shoreline and many others have much more knowledge than I do.

Finally, I am so fortunate that my Internist takes care of my Pain Management issues, since my PM doctor closed and moved. She (my Internist) simply went on the PM's suggestions and previous treatments. Maybe your primary care doctor could help in this way. But, many primary physicians are hesitant to do this. It is a suggestion, however!

Keep us posted on your situation.

Sincerely,
Jon (Conductor)

ARANGER · 03-13-2006, 08:39 PM

Hey Pookey

Welcome to the boards

I hate to be the bearer of bad news, but your Dr may be construing your lack of getting injections as refusing his treatment. With that said, I understand the reasons you cancelled, however, he may view it differently.

With them not calling you back is an issue. There is a saying that the Squeaky wheel gets the grease. Keep calling. If you don't get a response, then call again.

I know that sometimes these PM Dr's do things that we don't agree with. However, we have to look at their positions as well. They are the most watched Dr's by the DEA than any other Dr's. If they think you are refusing treatments, they may think that you are just after meds. I know that is not the case, but you really need to let the Dr know whats going on. Communication with a PM is very important. At the same time, its very difficult as they are busy. In their jobs, its easier to drop someone from the program then to risk something.

I would definantely be talking with the Dr. Take notes of how many times you called and didn't get a response. Remember this, Dr's keep notes on you all the time, its important that you do the same to cover yourself as well. Many times the Dr's have no idea that a patient has called. I would go into his office with dates and times of phone calls and the responses or no responses that you received and by whom if you can remember.

I hope everything works out for you at your appt. Let us know how it works out for you. Take Care

conductor · 03-14-2006, 08:45 AM

ARANGER,

Excellent answer!

Jon (Conductor)

pookeysmom · 03-15-2006, 08:00 AM

Thank you for your responses. It really helps to know that other people understand and they care about what happens to me. I am sorry that there are so many of us dealing with this crap. I know that they can do what ever they want, it just doesn't seem fair! (yes i know, who ever said life was fair?)

Anyway back to my story:
The nurse practitioner did call me (right after I made the post - are they watching) that afternoon. I was taken off guard and I have trouble communicating (verbaly) when I get angry, so I didn't say all the things I wanting to. He asked me politely asked me what was going on, and I told him that I just wanted answers to my medication questions and that I wasn't trying to get out of the injections. I thought that if they didn't have time to call me back that I would make an appointment and ask my questions then.

He said that as far as the medications go it was really up to me, if I thought that taking both neurontin and lyrica was working it was safe to continue both. Also he said that it was okay to continue with the cymbalta if I wanted to, he said it is probably helping with the pain. It was really odd. He said that I should cut the office staff a little slack because they are so busy. I didn't know what to say.

Yesterday afternoon I went in for the procedure as scheduled. When the nurse took me back to wait she was very nice. When I asked her which injection I was getting she showed me the consent form, it was for a medial branch nerve block. She said that if I had any questions at all she would get the Dr and that he was always happy to take the time to answer any questions. This was never offered before. I told her that I didn't have any questions, since the nurse practitioner had explained the procedure at my last visit. I was thinking that I would prefer to talk to the Dr about my other concerns at the follow up appointment, I'd rather not get all worked up before the procedure, and it did seem like the staff may have already been told to be nice.

The procedure itself was not pleasant, it was vey painful. I found out after my first couple of injections that if I would like a sedative they can do the procedure at the hospital but I would need someone to drive me. I have tried to avoid that and tough it out without any sedation, but I don't think I can do it again. I don't know if they can do the next trial nerve block with sedation because I am supposed to let them know if the pain goes away during the 1st 2 hours.

The good news is that I think that it worked! I have had pain in my neck and upper back for so long, it is wonderful to think that if they can deactivate the nerve I may have a near permanent solution, at least for the upper back pain. There may be a few other places that will need the same thing but we will deal with that later. I will see what happens with the next try.

I am going to talk to my Rhuematologist to see if she would be willing to prescribe my medications (especially the pain meds) if I have any further problems. My PCP really doesn't like to pescribe opiates. For years I was lucky to get the steroid pack when my lower back would go into spasm.

Thank you so much for your advice and compassion.

(BTW I have neck, upper back and lower back pain, and chronic muscle spasm due to Ankylosing Spondylitis, Rhuematoid Arthritis and Fibromyalgia)

Thanks again for listening,
Pookeysmom