Shoreline

Hi J44, Sorry to hear about your DX, If it wasn't a surgeon that found it, I would think the first place to go is to discuss a surgical solution, If there isn't one or the riskis too great, the next step is pain management. Please don't take anyone other than a surgeons opinion or even several surgeons, Too often PM doc and GP are making recomendatuions and not refering a patient to a surgeon when they may very well be able to help. Because every doc has their opinion about back surgery or spine or head surgery, it wopuldn't be uncommon for a GP or PM doc to tell you there is no surgical solution and never make a referral to a doc. I've met too many people n PM for their back that have never even spoken to a surgeon to se if there is an alternative to opiates.

If the genneral concensus among the surgeons you consult believe there isn't a surguical solution, and aren't willing to take on chronic pain patients they can't fix and your present PM doc isn't managing your pain,, then you need to consult other PM docs to see what your options are.

Not all PM docs are created equal, or have the same background. Some PM docs are anesthesiologists', some are physiatrists "physical medecine and rehabilitation" Some are neurologist, internal medicine,psychiatry, DO's etc. Depending on what may or may not help, kinda determines what type of doc you need. If there are interventional procedures, like spinal injections, nerve blcoks, etc, I feel better with an anesthesiologist when it comes to needles and my spine. Some surgeons, both ortho and Neuro practice PM, but not all surgeons will prescribe meds if there isn't a way to fix it.

Neurologist do tend to specialize in headaches, if you break PM down into sub specialties. But any doc that can write a script can call himself a pain management doc. It's up to the patient if they want their pain management doc Board certified in the 3 specialties that have a certification process for PM. Those are Neurology, anesthesiology and physcial medicine.

Every doc has a different opinion when it comes to what works or what meds or procedures they believe are most effective, so it's not uncommon to spend a few months letting one doc try their methods and then moving on to another doc that uses methods the other doc doesn't. Not every PM doc can or will do everything that's available. Any doc can prescribe pain medication, not every doc will do nerve blocks , uses botox, specific drug infusion, TINS, TENS, acupuncture, Trigger point injections, myofacial release, physcial manipulation like chiropractic etc etc etc. There are dozens of meds and modalities modalities to manage pain including self hypnosis, Bio feedback, guided imagry, counseling, etc.

The more tools you have that work, and the more docs available at a PM clinic that have docs from several specialties, the more likely you will find a combination of things that help rather relying soley on a doc willing to prescribe as much opiate pain meds that it requires to manage your pain.The key word is manage, not eliminate. Any legit doc is going to shoot for the most relief they can give without impairing you more than your original problem. 50% seems to be a the number I here the most and what the makers of the implantable morphine pumps recomend and call a succesful pump.

Not every doc is able to manage an implanated pump, if he isn't he will likely want you to try everything he can offer before admitting his methods don't work. Going from nothing to a pump is a huge leap when something less invasive may work. The problem is, people know opiates work and tend to be less then satified when their PM doc isn't managing their pain or prescribing pain meds. Some believe in their benefit, some believe their other combos are more effective and don't create the dependnece that opiates do. Only you can decide if the methods work and if the benfit outweighs the negative aspects of using opiates..

A PM clinic that has multiple docs from different specialties will certainly be able to offer more modalities and methods to help you manage the pain and learn to live with the pain that even opiates can't relieve.

Good luck, Dave