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Old 01-21-2009, 06:28 PM   #1
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Questions about hospitalization for Pain Management

My bf who suffers from chronic pain (from back surgeries) wants to be hospitalized to get the pain under control since its not working by just going to his pm doctor. We know that Mayo Clinic in Rochester has an in house pain management program. Has anyone here gone there and did you get the right help? And does anyone know of a hospital in the NY area that has a program in the hospital? He is just suffering way too much and its out of hand already. He keeps saying that he wants to go to the ER but his recent MRI is normal so they can't help him much. His pain meds don't work well either anymore. His surgeon can't help either.

Thanks,
Lynne

 
Old 01-21-2009, 10:17 PM   #2
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Re: Questions about hospitalization for Pain Management

Sorry it is long, but I had lots of thoughts and questions. I know someone in Arizona who went to the Mayo Pain management clinic in Arizona and were extremely satisfied. The one thing I learned about going to Mayo is that they really do stop and focus on your case and consult in all they need right away to get help. Sometimes in the PM clinics they are just pushing through so many patients because there aren't enough specialty doctors in some states. They sometimes do not really get the time they need to truly stop and make sure the patient is where they need to be. Not saying his doctor is bad - but if he really isn't getting help maybe it is time to get a new doctor. My PM worked tirelessly to get me in a good range.

I don't know if you have ever had chronic pain, but we patients go through many difficult times, not only with the physical pain but emotional and mental adjustments and acceptance. The goal of pain management is not to completely be pain free - that would take toooo much medicine and the way the meds work, some people need more and more over time. There are others on here smarter about that aspect than I.

I find it hard to believe that if he has had prior back surgeries, that they say his MRI is "normal". Things might be corrected but most people have some remenant stuff even after surgery - some doctors don't pay attention to the "mild" stuff. Time and time again on these boards you will find people with mild stuff having significant pain issues. Getting the proper diagnosis is key to treating pain.

Not sure what you mean by "not under control", are you saying in the 10s all the time, spikes in the 8's, or just constant 6's or what? Just trying to understand what his perspective is and what he is feeling. Has he modified his activity level - or is he still trying to run a marathon? Does he had a high intensity/physical job? Is he showing signs of depression? (All these things can affect pain level)

I am a chronic pain suffer myself from multiple spine surgeries and also had a very hard time getting relief so I do totally understand, I would just appreciate a little more info so I could get the picture. Do you know the names of the meds (we do not use the dose strength on here). Has he tried other things like epidurals or blocks, etc.? Has anyone talked to him about an implanted neurostimulator or pain pump?

The ER is usually usless most of the time. THey see too many drug seekers so they aren't real easy to get real pain help from. If he is seeing a PM he also doesn't want to break his contract (assuming he has one). No pain meds from anyone but PM is usually the course.

I'll check back for any answers from you. NP

 
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Old 01-22-2009, 02:25 PM   #3
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Re: Questions about hospitalization for Pain Management

If your bf is suffering really bad I would make him go to the er and let them help him and tell them he is hurting really bad and needs help.Let me know how is.

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Old 01-22-2009, 03:04 PM   #4
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Re: Questions about hospitalization for Pain Management

Lynne, I'm sorry to hear your guy is suffering. I am not familiar with the program at Mayo. All I can tell you that it's tough going to ER's for pain control. Especially if he's seeing a PM. The point of PM is that usually we are on stronger meds than the ER would send you home with anyway. Did he sign a pain contract with his PM. Most usually allow ER for pain but some do not. Has he called the doc? Did the doc say go to the ER?

The problem for pain management patients going to the ER for pain is many times the treatment is not very good. They have a preconceived notion about pain meds and many times will not help.

Although, if he is in unmanageable pain, you guys might not have any other option. Just be prepared especially if his MRI is clean. That doesn't mean he's not in pain, it just makes it harder to prove. If you're lucky, you may get a compassionate doc and he will help.

Has he had other tests to see what's going on? How long has he been in pain and seeing a PM doc? Is he on strong meds already? I hope he can get some relief.

Melissa

 
Old 01-22-2009, 09:34 PM   #5
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Re: Questions about hospitalization for Pain Management

Wow..thanks NP. I really appreciate your response and I will do my best to answer as much as I can so you can help us.

His PM dr is new to the practice since the one we had for about 2 years left and we are really bummed out cause he was great. Its taking time for the new pm dr to get to know my bf. He hasn't made any changes yet. He does really seem to want to help and takes his time at the appointments but nothing has really happened at them.

My bf definitely understands that he will probably never be pain free. He just wants it under control. His pain has been a constant 10 or up in that range and he hasn't been able to function much.

As far as his MRI goes, we've seen several doctors and they have all said that they don't see anything in the MRI that would be the cause of his pain. He did have an EMG which shows neuropathy that wasn't there before the surgeries but that can't be fixed with surgery. If there is anything on the MRI that isn't being read properly we wouldn't know it yet.

My bf isn't very active these days. He doesn't work. He has been on disability for years. He was very active until the surgeries. He is very handy and can fix anything and he is really bummed out that he can't do this stuff anymore which totally depresses him. He just started seeing a therapist and he is on antidepressants.

His pain meds are fentanyl patches and oxycodone for breakthru pain. He did go for several epidurals for a few years before the surgeries but they stopped working. And the shots damaged his hips so much that it caused him to get a new right hip this summer.

And yes, the pm doctors and surgeons have spoken to us about the pump and stimulator but right now its not a good idea for him to have any procedures until he gets stronger. He has had a few infections and has autoimmune problems and so his internist wants him to stay clear of any procedures for a while.

And lastly, the pm doctors never had him sign any contracts.

Thanks again,
Lynne




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Old 01-23-2009, 11:51 PM   #6
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Re: Questions about hospitalization for Pain Management

Lynne , I go by Denise. Thank you for answering my questions-that helps me understand. This is complicated so it can't be written in short paragraphs. Some similarities, I too have an autoimmune disorder mine is hashimotos thyroiditis, it injects lots of complications to my situation when my levels get off. Another FYI, I take the same meds.

I did look for you and found a comprehensive inpatient pain program at
NYU Medical Center. I found mostly when you go to a teaching and research hospital you are going to find good programs. Don't know if it is good, but you could research it.

Currently I use a combo of things, not one thing does it by itself (1.epidural injections at various levels in my spine (the last set they injected Fentanyl directly into my spine and it brought the pain levels down to where we could manage them again, I think this is very similar to what the pump would do on a continuing bases, I use the patch and bt meds, neurontin in cycles for nerve pain, activity pacing, mental relaxation - plus all the other ice/heat, etc..

If after reading the scale I included below if he is in the 9-10s by that scale then Lynne if I were you I would be immediately talking to all the doctors on the case and demanding an immediate action plan for bf. It is inhumane to let someone suffer this type of "9-10" pain for ongoing time. It isn't good for the nerve wiring either as our bodies learn about pain and recruit other, even healthy nerve cells to join the club.

1) Depression:

It sounds like he is at the end of his rope. I made big strides with the help of a pain physcologist (PS). In the beginning I went 2 times a week, eventually 1 time, then now I only go once every 6 months just to check in and tune up my skills. I hope he is seeing is a specialist in pain psychology . That is what Mayo would do with him as well. When my pain was out of control I was in a severely depressed state and it made my pain (or preception of the pain) worse. It is like a vicious cycle - they feed on each other. Focus getting the depression under control and increasing the coping skills and techniques. This can be done while you are figuring out the other stuff to do. My PS used guided relaxation, it's almost like hypnosis, and it WORKS. When done correctly it is like a temporary pain free place. I eventually got to where I could do it myself at will. Also use lots of music, quiet, relaxing kind. Studies have shown music is something easy to add to your pain management plan that helps. For anyone that doesn't believe in this stuff, I tell them have you heard the stories about people who had to cut off their arms to save themselves? They got their brain thinking in a different place - that is what the PS will teach bf to do.


2) Pain levels.

Out of everything this is the most critical thing when dealing with the doctors. When you are accurate with them - they listen more and seem to be able to reconcile what your are telling them and what they are "seeing". They are scientists and facts are really important.

Pain

1 (mild) Most of the time, you donít even think about it. Itís like having a mosquito bite.

2 (discomforting) Like when you get a hard pinch.

3 (tolerable) Like getting a shot. You adjust to it.

4 (distressing) Deep and strong, like stubbing your toe.

5 (very distressing) LIke constant mild back pain, walking on a sprained anke. You notice it all the time and become preoccupied with relieving the discomfort - normal activities are curtailed.

6 (intense) Deep, piercing or burning pain, strong, causes unclear thinking, inability to focus long on anything but the pain. Like a very bad sinus or stress headache and a bad back ache together. Most people can't hold jobs or maintain social relationships with constant 6 pain.

7 (very intense) This pain dominates your senses and you can't perform many of your normal ADLs , even simple stuff is impossible because you are so focused on pain. Comparable to migraine.

8 (utterly horrible) So intense that you cannot think, pain is now so intense that you cannot think clearly at all, and you might even go through personality changes. This level of pain would be comparable to child birth or a really bad migraine headache.

9 (excruciating/unbearable). Your pain is so intense makes you stop activities, social interaction, even answering simple questions becomes extremely difficult. It is difficult to think of anything else but your pain at this level. You may be severely uncomfortable even during rest or quiet times.

10 (unimaginable) Pain so powerful you are writhing and can slip into unconsciousness.



I hope I helped.

NP

 
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