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Old 07-29-2008, 09:51 AM   #1
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Pain Management Doc for Migraines

I am new to this board and just have a question regarding pain management doctors.

I have a very strong family history of migraines. Several of my family members have almost been disabled with them. I had never had one until 3 years ago. At that point, they came hard and often. I found a great, compassionate neurologist. He has tried me on just about every preventative and rescue med on the market. Then only one that I haven't tried is Topomax because I have a history of kidney stones.

The past 10 -12 months, I have been on a regimen that has been working great. For preventative, I take Verapamil and Nadolol (both BP meds, I believe). Since my migraines seem to be completely related to changes in barometric pressure, he has prescribed Relpax, Prednisone, Zofran and Lortab to be used as rescue meds. He told me to be very consistent in watching the weather and any time that I know the Barometric Pressure is going to change very dramatically or if I know my sleep patterns are going to be disprupted - I work nights at times), I am to start those meds before a migraine starts. He has also prescribed a few Dilaudid every month in case the above meds don't work along with nasal Lidocaaine. All of this seemed to be working great. He also filled out a form for me to keep at the Urgent Care and the ER outlining what meds to use in the case that my home meds weren't working and I had to go the ER. I have gone from 1-2 visits to the ER a month to 1 every 3-4 months, at the most - which I consider a huge success.

Here is the problem. Out of the blue, his nurse called me last week and told me that he thought it would be better if I was followed by a pain management doctor. It caught me completely off guard and to be perfectly honest, my feelings were so hurt. In his defense, in the past year, a "celebrity" that lived in my county was found dead and his death has been blamed on steroid and painkiller abuse. I have heard some doctors (including my neurologist at my last visit) say that the DEA is coming down so hard on all the doctors in this county. So, maybe that is why he referred me to PM, I just don't know.

My question is: has anyone ever been treated by a Pain Management doctor for migraines only? If so, can you give me an idea of the kinds of treatment you have received? Has it been successful? I have read through many posts on this board and it seems that everyone has other pain issues and not migraines only. I just wonder if this PM thing is overkill for migraines.

Sorry this is so long but thanks for any help you can give me.

 
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Old 07-29-2008, 11:08 AM   #2
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Re: Pain Management Doc for Migraines

Hi migrainemom,

Welcome to the boards. I'm glad you found us. Not that I'm ever glad that anyone has the need to find a forum like this, but this is definitely the right place when you need one.

I would think that most PM docs would treat any kind of chronic pain. It is more about the pain itself as opposed to the cause. So, it might just be the best option for you. I know you felt hurt that your current doc would just seemingly "pawn you off" on a PM doc, but the truth of the matter is that most GP's and specialists do not like to do any form of long-term pain management. And rightly so, I guess. They are in a specialty that they chose to pursue and I think they just prefer to stick with that, and leave the PM to the PM docs.

There may also be some merit to your conclusion about the recent celebrity death and the DEA cracking down. Many docs, both PM and other specialties, have been shaken a bit by all of the negative publicity surrounding prescription meds and abuse. But in the long run, I'd be more inclined to think that he is just not comfortable with long term PM.

I don't think that PM for migraines is necessarily overkill. If it's chronic and causes pain, then in my opinion, it's a PM issue. Did your doc give you any names or recommendations? Has he got a specific PM doc in mind? I would ask him to recommend someone, if he hasn't already done so. This way, he might be able to steer you in the direction of one who has specific expertise in migraines or other chronic headache issues.

Best of luck with whatever happens. Please keep posting and reading when you can. This board is such an amazing place to share your pain issues and specific knowledge and to gain wisdom and support from others who truly understand. Take care and let us know how it goes. CMP/MM

 
Old 07-29-2008, 11:32 AM   #3
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Re: Pain Management Doc for Migraines

Hi CmpGirl:

Thanks for your reply. It helped me feel a little better about PM not being overkill. Yes, my neurologist actually set the whole thing up - he called the PM clinic and has had them call me to set up an appointment. I just haven't called them back yet as I wasn't sure if that was the right thing to do or not. I guess I am still hurt that a doctor whom I thought I had established a very good relationship with had his nurse call me to tell me that I needed to see someone else. I know he is busy but as you must know, your doctor becomes like your lifeline and you have to trust them in order to allow them to help you. I don't know - I guess instead of viewing it as a business as I should, I have been viewing the whole thing so personally (does that make sense?).

Anyway, thanks again. I guess I should just go ahead and make the appointment. Any ideas on what PM Clinics do for migraine sufferers? Seems like I keep reading so many things on this Pain site about other pain sufferes getting many types of injections, etc. That just scares me and makes me hesitant to go; however, I am sure if I was suffering with a migraine at this time, I wouldn't care what they did to me if it relieved the pain. When I go to the ER, the first thing I do is stick my arm out for an IV - cause, in all honesty, who cares about needles when your pain is so bad you feel like cutting your head off?

Hope you are having a great day and thanks again!

 
Old 07-29-2008, 11:51 AM   #4
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Re: Pain Management Doc for Migraines

Quote:
Originally Posted by migrainemom View Post
I am new to this board and just have a question regarding pain management doctors.
Welcome! Glad to have you aboard. There are many regular posters here who all have a wide variety of experiences....Many of whom can probably help in some way.

Quote:
My question is: has anyone ever been treated by a Pain Management doctor for migraines only? If so, can you give me an idea of the kinds of treatment you have received? Has it been successful? I have read through many posts on this board and it seems that everyone has other pain issues and not migraines only. I just wonder if this PM thing is overkill for migraines.
I have had them for years, among other issues. I've been in official PM now for about 5 years....Before that, my ENT treated my pain. I've been taking pain meds for about 10 years total. Narcotics have worked very well for my headaches and migraines. I tried just about everything prior and not much worked....Maybe slightly. Narcotics are the only thing that knock the pain out and when I feel one coming on, I hit it hard. I have found that a ounce of prevention is worth a pound of cure....At least with my pain.

Quote:
Originally Posted by cmpgirl View Post
There may also be some merit to your conclusion about the recent celebrity death and the DEA cracking down. Many docs, both PM and other specialties, have been shaken a bit by all of the negative publicity surrounding prescription meds and abuse. But in the long run, I'd be more inclined to think that he is just not comfortable with long term PM.
I agree with Campgirl....Where there's smoke, there's fire. Unfortunately, all it takes is one public episode, and all you know what breaks loose. Legitimate PM patients invariably get caught in the middle.

I would set up an appointment with the Doc and make him tell you face to face what's going on. Just play dumb and ask "why"? Tell him you are concerned about seeing some new.....And, @ the very least, ask if he can really take his time to explain to the next Doc exactly how much pain you are in. I can definitely relate to your comment about your head being cut off....Been there, felt that!!

Quote:
Originally Posted by migrainemom View Post
My neurologist actually set the whole thing up - he called the PM clinic and has had them call me to set up an appointment. I just haven't called them back yet as I wasn't sure if that was the right thing to do or not. I guess I am still hurt that a doctor whom I thought I had established a very good relationship with had his nurse call me to tell me that I needed to see someone else. I know he is busy but as you must know, your doctor becomes like your lifeline and you have to trust them in order to allow them to help you. I don't know - I guess instead of viewing it as a business as I should, I have been viewing the whole thing so personally (does that make sense?).
It makes perfect sense. Again, I would set up an appointment to talk to him. You could go ahead and set up the PM appt and in the meantime, set up an appt with him and go see him. Nothing says you have to do them one after the other. I would also ask that if the PM Doc treatment doesn't go well, could you return as a patient? Just explain exactly how bad you do feel and unless someone has walked in your shoes, it's hard to really understand.

I'm also speculating that because your Neurologist is referring you, things will be very legitimate right off the bat. Let's face it....if a Neurologist can't find ways to stop the migraines non narcotically, how is a PM Doc?? Time will tell I guess. However, I wouldn't be afraid of trying narcotics....If it works, then they're a God send....They have to me!

Good luck and let me know where I can help.

Ex

 
Old 07-29-2008, 11:59 AM   #5
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Re: Pain Management Doc for Migraines

Executor: Thanks so much for the reply. I have to tell you - you made me feel so much better regarding my meds. It seems like I see more info saying that many doctors swear that narcotics don't work for headaches/migraines. I thought I must be crazy. The regimen that the neurologist put me on has cut my ER visits by more than 1/2 (probably by more than about 3/4). That is why I am so confused. I thought I was doing exactly as the neurologist told me to do. Then, when he dumped me all I could think was he didn't like prescribing my meds. It is just so darn confusing. The key to my meds working, however, is taking them before I can even feel the pain or at least when the pain is very minimal. If I wait until I know I have a migraine, then it is too late. Seems like a guessing game but I had been doing pretty darn good.

Do you see PM only (I say only not to downplay our headaches but just to verify you don't have back/neck/leg etc. problems) for headaches? Do you mind if I ask what meds you take and do you take them on a schedule, when you feel a headache coming one, when the weather changes, etc.?

Thanks for your help and your support. This place is awesome!

Hope you are having a headache-free day.

Last edited by migrainemom; 07-29-2008 at 12:01 PM. Reason: Forgot something

 
Old 07-29-2008, 06:56 PM   #6
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Re: Pain Management Doc for Migraines

I see an ENT and a PM Doc. My issue(s) are complex and some are post surgical in nature...Due to "mistakes" in the O.R. I do not have any neck or back issues. I also have severe allergies / headaches. I take a LA med, Avinza, once a day and then meds for BT pain, or "rescue" meds.

Ex

 
Old 07-29-2008, 07:44 PM   #7
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Re: Pain Management Doc for Migraines

I have to admit I find it kind of strange that a Neurologist, who actually specializes in headaches, would drop you for a PM doc. I have cluster migraines, the last one being for 16 days and I'd never feel comfortable if my Neurologist sent me to PM. I mean a PM doc really isn't trained in headache management. I take Topomax as a preventitive and it has caused kidney stones, had to have 1 surgically removed last year, and have another one currently that we're "watching", but it also has controlled the migraines, so the benefits outway the costs so to speak, I also use Axert and Percocet or Dilauded at oncet, depending on how bad the pain gets. Good luck to you I hope your new doc treats you well.

 
Old 07-29-2008, 07:55 PM   #8
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Re: Pain Management Doc for Migraines

Kmit and Executor: Thank you both for your responses. I agree that it seems so strange to have the neurologist send me to PM. I guess I need to get over the hurt feelings and just concentrate on finding another "somebody" before I run out of meds - including my daily preventatives! It is difficult, though, since I truly thought we had a great relationship. Executor, I did write my doc a "thank you" note saying thank you for treating me, sorry if I did something "wrong" and I am totally confused as to why you have decided not to treat me. I thought I might at least get some kind of response but that has been about 4 weeks ago and nothing, so.....

Anyway, just being able to vent on here has been helpful. I guess my next step will be to at least call the PM clinic where the neurologist sent my records and talk to someone on the phone. Then, depending on the answers that I get (if I get any), I will then make an appointment just for evaluation and consult. I guess when I read all the posts regarding the "contracts", urine tests, pill counting, etc. that everyone on the chronic pain board talks about, I am not sure if it will be worth it. My answer would be that I would rather suffer through migraines than suffer the humiliation of all that but I say that as I don't have a migraine at this time. Ask me if I still feel that way when I am hurting and vomiting and my answer may be different. I guess I better decide soon, though, since it seems it may take awhile to get in to see anyone.

Thanks to both of you.

 
Old 07-29-2008, 07:58 PM   #9
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Re: Pain Management Doc for Migraines

MigraineMom,

Sorry I just caught your post on the other board, so here is the answer to your question besides what I posted below.


Chronic Knee Pain, 9 Surgeries, Left & Right, Replacement Left to be done this September, then Replacement Right to be done one year from that. : Fentanyl patch 50mcg/48hr, norco 10/325, and ultram 150mg/day, Ibuprofen 2000mg/day.

BiPolar II Disorder and PTSD: Seroquel 300mg, Lamictal 300mg, Zoloft 50mg, Neurontin 300mg, Vitamin D 1000IU.

Cluster Migraines:Topomax 100mg daily and Singulair 10mg, Axert, Percocet and/or Dilauled at onset.

I've also had 9 various abdominal surgerious in the last 10 years but currently the only lasting problem I have is one kidney stone in my right kidney.

 
Old 07-29-2008, 07:58 PM   #10
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Re: Pain Management Doc for Migraines

Oops, sorry. I forgot I was on the Pain board. I guess the both of you can completely understand what I mean. When I read about all that everyone who suffers with chronic pain has to deal with to get treated, it makes me cry. Question: if you had cancer, would your doctor's office treat you like they do while treating you for pain? I just don't think it is fair and I haven't even been through it. Don't you all wish there was some kind of reliable way to truly measure pain just so that your docs would know how much you are suffering?

Anyway, thanks again!

 
Old 07-29-2008, 08:55 PM   #11
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Re: Pain Management Doc for Migraines

I can't stress enough that you need to make an appt and go see him....Make him tell you face to face what the heck is going on....He owes you @ least that. It's probably something out of your control, but @ least you'd know. If it is DEA stuff, then I'd ask him very politely will this also effect your care @ a PM Doc?

Ex

 
Old 07-30-2008, 11:11 AM   #12
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Re: Pain Management Doc for Migraines

Migraine Mom,

In all fairness to my docs, I have to say that I have a great team of docs being a PM, Neurologist, GP, Urologist, 3 Orthopaedic Surgeons, Psychiatrist, and Psychologist who have all been very attentive and taken very good care of me over the years. So I can't really complain about that. I realize that I am very lucky compared to others that post on this board.

 
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