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Old 03-21-2006, 07:45 AM   #1
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First appt. with P/M Doc, what to expect?

Hello to all,

Regular G/P has referred me to a PM doc. Can anyone tell me what to expect.......I have a bad back due to a fall years ago. My G/P limits me to only 30 pain pills per month, when I asked for more, he got upset and sent me to a PM doc. I tried to find relief going to a Chiropractor, he did by the way do X-rays and found there is some disc damage, but the report that was sent to my G/P said nothing was abnormal. I get so much relief from meds and am able to live a somewhat normal life, there is still pain, but the meds most certainly help. Certainly having a 2 year old at the ripe old age of 42 does not help lifting him up all of the time,

So is this "new" doc going to cut me off completely to my meds and want to start a all new "natural approach"................any info would be so helpful.

Thanks so much........

sons2

 
Old 03-21-2006, 08:38 AM   #2
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Re: First appt. with P/M Doc, what to expect?

I had been seeing my Gp for a few months and he was giving me Tramadol, and Vicadin ES For 3 -4 a day and he would give me 90 at a time. when I told him the meds weren't helping me he than referred me to PM. I have a bad back to, have already had one surgery and I need another one but I am trying meds first. I constant low back pain and sciatic pain all the way into my buttocks, leg and the worst pain is in my left foot its so bad at times I can't walk and sitting is horrible for me. I have had the pain since Last March so a year now. for a long time I just took tramadol and motrin but that was not enough for me I was in tears and bed bound a lot. the pain managment Dr I saw at the first visit told me he wanted to put me on LA ( Long acting meds) since my pain is chronic. he started me off with percocet around the clock, like 9 a day. than he put me right on oxycontin long acting, and he gave me 10 mgs a day 3 a day. now I go back in a week and i will ask him to raise it up as I am in still in a lot of discomfort, its just not enough for me. his PA did a really good exam on me and so did he and a lot of questions and a good back ground history on me. I had all my records and we went over everything. at this point I am going to get stabilized on pain meds and than we are going to start neurotin for my nerve pain and light excersises. I am a canidate for steroid shots but I just plain don't want them and he understands that. so that is how my apt went. I am sure you will be asked to fill out a big contract on your meds and these pain med docs are very strict about taking you pills exactly as the prescribe them. once you get the paper work you will see all the rules of being there patient. but I am sure they are not going to cut you off you pain meds. my Dr aslo asked me to bring in my pharmacy records so they could see what meds I was on and who I was getitng them from.

 
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Old 03-21-2006, 08:55 AM   #3
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Re: First appt. with P/M Doc, what to expect?

Most PM doctors do not cut you off your current medications and go "natural" so don't worry about that.

Here's what you should do however:
Take copies of any and all medical records and tests that relate to your current situation so the doctor knows what is wrong, what has been tried and what your current regimine is if possible or at least a list of your current doctors and places you've had tests so they may get the records for you.

If your appointment isn't for a few weeks or month(s) start keeping a pain diary, keep notes of when you hurt, how much you hurt and when you took medications and how you felt afterwards.

When you go in you'll have general paperwork to fill out and nearly all doctors will give you a contract explaining about narcotic pain relief, that the goal of PM is not to have 100% pain relief but to minimize the pain (100% just isn't viable in chronic pain) and have you agree that you can not see any other doctor for pain management nor can you have any other narcotic type medications prescribed to you by any other doctor, including an ER. You may also have to agree to random drug screens and pill counts. You must understand and sign the agreement before you can even see the doctor in most cases.

Your doctor will most likely ask you about your history, what prompted the visit and how you are currently feeling along with current medications. He or she will then discuss a treatment plan (usually). Your doctor may or may not suggest phsyical therapy and psychological counseling (for pain management) in addition to prescribing any medications. He or she may also order additional tests and also offer or discuss having blocks, cortisone injections and the like.
Your first visit will probably be the longest of any visits that you do have with him or her.
Honestly it's just like any other doctors visit when you are sick but the main focus being that you have irritractable chronic pain and the goal is to give you some quality of life.
Generally the doctor will prescribe some sort of medication (you did not say what you were on). If your current medication is reasonable he may just increase the dosage and set a new apointment in a few weeks to a month to see how you are progressing with the medication. From that point on it's all trial and error in finding what works best for you. Some doctors require you see them every 28 or 30 days (especially in the begining) while others allow for a longer period of time between visits.

I do suggest that during your first month with this doctor you do keep a pain diary and medication diary. Keep track of your pain levels and when you take medications as well as how you react to them. Bring it with you to your second visit so that you can discuss what's happening with your current regimine. He may or may not change medications after that point. Again, it's all total trial and error. Most doctors, as a general rule, will try to give you the most minimal medication to help with the pain so don't expect to go in and get Morphine or Oxycodone prescribed right off the bat or something equivalent (it does happen but it is based on past history, condition and doctor). If something that is not as strong works all the better for you.

Also bear in mind what works for many of us here may not work for you as most of us have been PM patients for many many years and we've gone through the regimine of low level medications to strong medications through a period of time.

Best of luck
Barb

 
Old 03-21-2006, 12:17 PM   #4
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Re: First appt. with P/M Doc, what to expect?

Sons2,

I agree with Kissa, she gave you good information about the PM

PM's are different, you can probably find 10 different styles just right here on the PM board. Some are med writers, some are all about injections, some don't believe in opioid meds at all (opiodphobic).

In my opinion, the best route to go is to have a PM that uses several types of treatment. Customizes it for you. That may be: Meds, Injections (sterioids), and PT. Basically something other than one treatment. It is important to explore different methods of treatment to find what works or what combination works.

As Kissa pointed out, I think it is important to keep a diary of your pain and what is working. Some Dr's will give you one to keep. You can also find them online or just make one up on your computer. Either way, something to show your PM what works and what doesn't work each day. PM is all about trial and error. Its also about the PM Dr being able to document in your file the reason for him/her treating you. PM's are the most watched Dr's by the DEA than any other. So documentation is important to them.

As you will read, some PM's have that "better than you" attitude. So, I guess its hard to say what to exactly expect. One thing to keep in mind is that PM Dr's are always getting people trying to scam them, get meds, fraud, etc. So some come off pretty harsh and it is unfair to the people that are honest. Like Kissa said, expect to sign a contract with your Dr and make sure to follow it to a T. Its all about trust. Trust is earned over time. You may be called in for Pill counts and drug tests and will be expected to be there and be on with your meds.

Anyway, I hope your Appt goes well. Don't be afraid to ask questions, and just be sure to comply with what they are asking of you. Best of luck.

Take Care

 
Old 03-22-2006, 05:16 PM   #5
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Re: First appt. with P/M Doc, what to expect?

I am considering filing for disability. Do PM docs fill out the paperwork? I have an appt for next month for a new one and just wondered. My back doc has had problems on and off and I haven't seen him in a year but have an appt with him as well. When my GP suggested that I try this other guy I said sure, just in case my original one cancelled the appt as was the case for the last few years.

 
Old 03-23-2006, 09:46 AM   #6
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Re: First appt. with P/M Doc, what to expect?

When it comes to filing for disability you fill out paperwork that then requests information from ALL treating physicians, past and current, that treated your condition. The more medical evidence you have the better. So in your case the Disability office (assuming you mean SSI or SSD) will request medical documentation and forms to be filled by not only the new doctor but the old one.

 
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