What you are experiencing re: your relationship (or lack thereof) is very normal and happens to a great deal of people. You have a great situation going for you that most do not have.....And that is a firm recommendation and evaluation by a specialist, your orthopedic. Not only is he the foremost expert in the area involving your pain, but by virtue of you being referred to PM, your situation is immediate legitimized. Thus, you cannot compare your situation in any shape, way or form, to most other people.
Conversely, most people end up at PM because they've complained of some type of pain via their GPs and at some point, either the family Doc can't treat it any more, or won't (not comfortable doing so). Additionally, most suspicious PM patients are those who don't really have any conclusive diagnosis or condition. For example, their back hurts but nothing really shows up on scans. Or someone says they have Fibro, and by the sheer nature of the condition, there really isn't any testing that can be done. I am in no way minimizing people with these conditions, but just giving you some real life examples.
The other thing you have to keep in mind is that although there are "stories" out there of negative PM situations...Fakers, abusers, and etc....They are by far the minority. In fact, not only are the vast majority of people in PM, good honest patients, but the few stories that happen, get lots of airplay because they are juicy topics. In no way do they represent anywhere near what normally goes on in PM. So, my point is to not let a few bad apples spoil the lot.
For example, my PM has a very large practice....About 2,000 patients. I've gotten to know him very well over the last 10 years and he told me once that he has to dismiss a couple of people per month. So if a "couple" represents an average of 3, then yearly, he dismisses 36-40 patients. While that may seem like a lot, it's only 1-2% of his patients overall. While I'm sure there are some juicy stories involving those 30-40 patients, no one talks about the other 1,960-1,970. That's issue # 1.
Secondly, in your situation, you've been referred to PM by an orthopedic, who is the foremost expert in your type of condition. The only reason the Ortho isn't treating you moving forward is because PM isn't his area of expertise. PM is much more than about prescribing meds....It involves tolerance and stability, and over time, most good PMs will rotate patients among a couple different narcotics in order to effectively manage their situation. I am very surprised that your PM didn't follow the Ortho's recommendation, at least initially. Was this because you didn't represent yourself correctly or because they elected to do something different? Normally, one gets referred to a PM because the GP can't control the pain anymore, or isn't comfortable with higher amts. I would tell the Doc that you were referred to PM because they couldn't adequately control the pain and now, you're getting less meds so you are even worse. If your PM Doc doesn't respond accordingly, I'd either be looking for a new PM, or see if your GP could take you back and then discontinue your contract with your PM (but talk to your GP first).
Not all PMs are the same, but because PMs deal with narcotics every day and is their main tool in fighting CP, they typically aren't afraid to prescribe heavier meds, or higher doses. Some of the doses I've seen or heard of are incredible....Places regular Docs would never go, but to PMs, it's fairly routine.
Your apprehensiveness is normal. But, as Backhurtz said, the PM Doc can't help you if you're not honest with him. You have to be your own advocate. It is critical
. Because your condition is very legitimate and you're coming to the practice in a very professional, legitimate manner, you have nothing
to worry about. Your only issue will be if your under represent yourself. And if that happens, then you will bear the unnecessary consequences.
In terms of your "goals" or what you are looking to get out of PM, should be exactly what you wrote in your post. I would be very honest with the PM Doc...Tell him what you wrote here.....Tell him your goal is to be able to get out of bed each day and enjoy life with your child. Tell him what struggles you have on a daily basis. Give him examples of certain tasks, whatever they may be. If he asks you to "rate" your pain, be honest and don't sell yourself short. Most PM's rate pain on a 10 point scale...With zero being no pain and 10 being the worst pain one could imagine. Most Pms will tell patients that their "goal" is to get pain down to a manageable level....Say a 5. It's probably unlikely and unrealistic to think one can have no pain. Actually, it's possible, but you'd be so sedated, you couldn't enjoy life.
Many PMers make the mistake of under rating their pain. What a # means to them, may mean something else to a Doc. For example, if 10 is the worst pain one can imagine, then 9 would be post surgical pain or very serious, debilitating type pain. 8 would be really bad pain...Probably causing one to miss work or school. 7 would be very bothersome pain...May miss work, but if they did attend, it would be obvious to all that something is wrong. 6 would be pain that prevents certain activities, but not all that bad in terms of missing work, school and etc. 5 would be pain that is constantly present, but one can function and do limited activities....This is what one should strive for, according to many PM specialists. Anything below a 5, many PMs will say that you shouldn't be in PM.
So, just beware of this scale if you're asked to rate your pain. Once you talk about the scale, you may ask the Doc what his expectation is for his patients....What # or range is a realistic expectation? Many PMers with daily chronic pain are typically in the 7 range fairly regularly, with upticks to 8 or what they call "break through" pain. I call break through pain a "flare up." I've only had a 10 once or twice and I about wanted to die...Literally. I've had some 9s and they are very debilitating.
Lastly, a great way to talk to a Doc re: specific meds, treatments and etc. is to throw other medical professional opinions out there as a way to legitimize the topic, or your position. For instance, if you'd like to try Oxycontin, you don't want to say "I think I'd like to try Oxycontin" but rather "In talking with my ortho, he suggested Oxycontin. is this something you'd also recommend"? Or, "I was talking to my pharmacist, and he recommended .........". As a general rule, Docs (not just PMs) usually don't like it when someone says "I was reading on line about this med and ........". Even worse is when someone says "I was on a message board and this one lady said........." Not good.
A big part of PM is communication, so hopefully this post have you some basic tips. In fact, there are two very recent threads on this very topic:
- "Re: This one might just be for the ladies (odd ?)"
- "Re: Need advice on new medication regimen"
Best of luck at your appointment....I'm sure it will go well. Please let me know if I can help further.