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Old 03-18-2009, 09:33 AM   #1
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1st visit to pain management - what to expect?

Hello all,

This is the first time that I have ever been to pain management and I have my first appointment on Monday. My X rays showed some disk issues in the L5/S1 area and I was also told that I was very "tight" in that area. My muscles pretty much stayed in a knot and muscle relaxers do not help. My pain is unbearable at times. I am scheduled for my MRI next week and was sent out the pain management because the Dr. I was seeing does not RX pain medications.

So, what should I expect from my first visit to pain management? Will they provide pain relief immediately or do I have to go through a series of steps before treatment is started?

I'm terrified of being put on Oxycontin or Roxy.

I just want relief from this pain be it medication or a combination of medication and therapy. I am currently on two different types of muscle relaxers as well as anti-inflamm. drugs that are not doing squat.

Thanks!

 
Old 03-18-2009, 06:59 PM   #2
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Re: 1st visit to pain management - what to expect?

Hello....Sorry to hear about your back problem and welcome to the pain boards. It's good that you are going to see a PM Doc....They are experts at fighting pain. Most PM clinics do things the same....They have measures in place to prevent abuse / diversion as much as possible. These are good things because by being prudent, your access to quality care and meds is protected.

The first thing you'll notice that is different than most other Docs, is that they'll probably have you sign a PM contract. PM contracts state that you understand the risks associated with meds and more importantly, you agree to regular drug testing, won't miss appts, and will not ask for meds to be replaced if they are lost or stolen. You also agree to only get pain meds from that Doc, and not other Docs. The conditions of the therapy are clearly laid out so that if you violate them and therefore dismissed, you fully understand the risks and why you're dismissed.

Many PM Docs will drug test at the first appt to ensure you're not an abuser. They'll also discuss your prior tests (Xrays & etc), med options and etc. They may order additional tests, depending on your situation. Some Docs won't Rx meds until the drug test come back, but many will....And if it comes back badly, then they dismiss you.

Your fear of pain meds is understandable....But in most chronic pain can't be controlled without meds....Unfortunately. Patients will eventually develop tolerance and dependance, but not addiction. They are very different and we can discuss in detail if you'd like. However, if you are completely against meds, then make sure you tell him/her right up front. However, if you take meds as directed and are prudent with them, I am a firm believer that the "pros" far outweigh the "cons." Hopefully, other regulars will jump in here and give you their perspective. This board is great at offering support, comfort, and many posters have a tremedous amt of knowledge.

Best of luck to you.

Regards,

Ex

 
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Old 03-19-2009, 06:13 AM   #3
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Re: 1st visit to pain management - what to expect?

Hi there & welcome.
I understand your fears & I was the same. When my PCP first wrote me a script for oxy I freaked alittle, said I was not taking it & so on... His response was if you want to stay out of ER & have some control you will give it a try. He would only prescribe narcotics for short term & that was it.

Every PM is different. Some will start prescribing the first appointment others want to try injections & such first. I am guessing what shows on that MRI will have an impact on what the PM recommends for you.
I am assuming you will have a contract to sign & I would recommend you keep a copy of any papers you sign or initial for yourself.
Ex did a great job explaining things for you. PM doctors are alot different then any other doctor you will ever see.
My PMs office told me to always carry the postdated paper scripts with me to the appointments incase he wants to make changes as you will have to hand it back in to recieve the new script. For ex: you have a script for 6o tablets & he wants to change it to 90 tablets, or your med is changed he will want the other script back for the other med. I made that mistake & had to go back the next day to exchange scripts. After returning home I always lock the scripts back up. I dont let anyone know I am on pain meds. Its amazing how people pass judgement & the people you cant trust.
There are tons of stories here on those 2 topics.
Good luck & I hope this PM works out for you, a good PM is worth their weight in gold. God bless, Sammy

 
Old 03-19-2009, 07:21 AM   #4
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Re: 1st visit to pain management - what to expect?

Thank you so much for the replies! Just know, I am not against pain medication and do not pass judgment on others who take them. It's just that with Oxycontin, I have had family members become very addicted to this medication and it scares me to take it. It did control their pain very well.

As far as drug testing, I'm sure I'll pass with flying colors. The only medications I have in my system are those that were prescribed by the Dr. who referred me to pain management. Thanks for the heads up because it's good to be prepared.

Like everyone else who seeks pain management, I need relief also. I'm 35 years old and can't even hardly get out of bed some days because my back and hips lock up on me. Degenerative disk disease runs in my family and I am frightened that I already have all the symptoms of this disease.

Again, thanks alot for the info. Whatever the Dr. orders, I'm sure it will be a great relief!

 
Old 03-19-2009, 08:44 AM   #5
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Re: 1st visit to pain management - what to expect?

You sound like me except I am in NC and you SC. My PCP wanted to put me on Oxycontin after presribing my Percocets for my pain. I had heard bad things about the Oxycontin and went to PM for other options. They did put me on a LA medication ( Now it is MS Contin) and I take percocets for BT pain. The injections and Radio Frequency Ablations have HELPED my worse pain. I finally realized that I wanted a GOOD quaility of life and couldnot be in pain all the time. The LA meds do NOT give any big rushes of :highs " that the short acting meds do but they keep pain levels pretty level. Some PM don't presribe meds on 1st visit but mine did. ( I did have records ) Taken only for pain, we do not become addicted yet our bodies do become dependent on the meds and get "used" to the meds and act up when we don't take them, ( minor Withdrawals from Dependency NOT addiction"

 
Old 03-19-2009, 08:48 AM   #6
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Re: 1st visit to pain management - what to expect?

You may already have been told this having DDD but my surgeon just reminded me to stay on 1000mg of calcium with D which I do. I am convinced it has helped my fusion to some degree, as I am dont take in alot through my diet & am not the greatest of patients.
I go to a compound pharmcist for my vitamins & he is really informative. I often say one of these days I am going to invite this guy to lunch just so I can have a full hr. of picking his brain. Good luck with PM & please let us know how it goes. Sammy

 
Old 03-19-2009, 12:28 PM   #7
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Re: 1st visit to pain management - what to expect?

Very good information. Thanks again!

Sammy, I am currently on calcium supplements (can't tolerate milk products) and hormone replacement therapy due to my total hysterectomy two years ago. The calcium is a great help to the bone aches. It's great that you have a compound pharmacy. I'll definately check in to what you suggested!

The DDD is still a concern. My grandmother has had bone fusion surgery due to DDD and spinal stenosis and my mother has had to have surgery to replace disk in her back. Both are totally disabled. Plus, two of my mom's sisters are in the early stages of DDD and I see what they go through with pain.

I just want to get back to normal again and be able to function at work, with my children and at home. Daily task are almost unbearable at times!

I go to PM Monday, so I'm sure I'll be sure to post the outcome of all that.

 
Old 03-19-2009, 02:44 PM   #8
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Re: 1st visit to pain management - what to expect?

Just so you know the only difference between Oxycontin and Percocet is acetaminophen(Tylenol).

Oxycontin (oxycodone)

Percocet (oxycodone + acetaminophen)

The other difference is that Oxycontin is long acting(LA) which means it last anywhere from 8-12 hours and the Percocet is short acting(SA) which mean is lasts anywhere from 4-6 hours although once you are on it for awhile it only lasts a couple of hours. I would not be completely against the Oxycontin just because some of your family members have had problems with it. There are many people on these boards that take it as presribed and have absolutely no addiction problems. I know that it is hard to break the stigma but just be open minded to what the PM doc suggests.

brian

 
Old 03-22-2009, 05:12 AM   #9
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Re: 1st visit to pain management - what to expect?

Yes please let us know how it goes. I just started taking magnesium also to see if it would make a difference with my pain levels. It is suppose to be a natural muscle relaxer so I thought I would give a try. I was just talking to a nurse the does homecare for a client of mine & she did not realize the compound pharmacist was this close by. She said we are lucky as they are far & few. She said basically the same as I they are a wealth of knowledge.
I feel for you as I know I worry about the DDD. Every doctor I have seen in the past year or so recommends the calcium. Even my clients doctors.
Good luck with your appointment, I am curious to see how it goes. Sammy

 
Old 03-23-2009, 11:09 AM   #10
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Re: 1st visit to pain management - what to expect?

Well, my visit to PM went well, I think. The Dr. asked me about my medical history, medications that I had taken, he checked my reflexes (was slack in the left heel and knee), checked my physically, asked where my pain was, etc.

He gave me an RX for pain meds, ordered an MRI and said that he was going to schedule me for an epidural after I saw him again in a month. Is it normal to get epidurals?

I also had to submit to a tox screen which came back fine. I mean, the Dr. didn't spend a whole lot of time with me, but he seemed like a nice person. I'm surprised that he wrote me an RX for pain medications on the first visit?

 
Old 03-23-2009, 12:01 PM   #11
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Re: 1st visit to pain management - what to expect?

Mine did. He gave me a Short Acting med and then prescribe me a long acting pain med which I had never had.
I have received trigger point injections as well as SI injections, That is where they make their money. but they can help too !!

 
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