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Old 01-25-2010, 08:35 PM   #1
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Advice when talking to pain management doc for first time?

Hi, all. I have an appointment with the pain management doctor on Thursday and just thought I would ask if anyone had ideas on how to talk to him. I get nervous in the Drs office and end up not saying things or expressing things the right way. I have fibromyalgia and ankylosing spondylitis as well as osteoarthritis. My VA doc wouldnt give me more than 2 7.5 hydrocodone a day and it just isnt enough to be able to function. I only work three 12hr days a week (the whole time of which I am in agony) and get to rest the other 4. The first day after I get off is what I call my 'dead day' because I basically do nothing but try to recover from the stress of my work week. My VA doc thinks I am a drug seeker, I guess they get that a lot. (at least that was the impression she gave me). I just want to be able to iterate how I feel without sounding crazy and desperate (which in a way, I guess I am).

At one point I was on 3 percocet a day as well as 3 flexeril a day. I wanted to try to cut down on them as my whole family has addictive tendencies (drugs, alcohol, you name it). But I have found its not that I am looking for a high, I am just looking for relief and the ability to not be a total ***** at work because I am in pain. I asked a friend who is an RN to write me a buddy letter to try to increase my va money and in it she stated that I had 'emotional outbursts' when I was in pain and the other staff worried. Made me feel like crap I tell ya. Made me realize that it affects me and is more noticeable than I thought. It was great for her to help me in writing it, but it was an eyeopener for sure.

Anywho.. any help or suggestions would be greatly appreciated, Thanks.

CS7

 
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Old 01-26-2010, 07:27 AM   #2
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Re: Advice when talking to pain management doc for first time?

I'll give it a shot. To be honest I cant imagine anyone who would not be nervous for the first PM appointment. After all this doctor is different then any other you will see & can hold the quality of you life in their hands. On the other hand you are interviewing him as much as he or she is interviewing you. Keep that in mind.

I would write everything down, any questions you may have, how & what effects you pain levels, what makes it worse, what makes it better etc... often doctors encourage you to do so. A good PM knows other doctors dont always understand people who live in daily chonic pain & form their own opinions. Try not to think to worry to much about your other doctor, as this is why your seeking a PM to hopefully avoid misunderstanding & poor judgement.
Take any films you may have with you or reports.

Im not sure about discussing your concerns about addictive tendancies in your family. Some doctors may understand others may be a little nervous by this. You may want to wait till you get a feel for this doctor. Im not saying you should not express your concerns, as I'd feel the same but you may want to get a feel for this doctor first. Im sure most people are concerned about becoming addicted, I know my husband & I discussed this after the first few visits.

IMO expressing how much your pain effects your daily life & limits you is important on the first visit. If you can take someone close to you who can lend support & knows how you battle pain every day. I cant say this about all doctors but my PM actually likes the fact my husband comes with me. He will ask him questions at times & I truely believe he likes the second set of ears. He will also ask him to keep an eye on how I respond to any new meds or changes. I realize not everyone has a partner.

I can see how you'd feel the way you do after reading the letter from your friend. It was kind of her to be honest as this shows one way your pain effects your life & it is important. You may want to note to the doctor you are appreciative of her honesty as you were so focused on working through the pain you never really understood this was occuring (something like that). That is a prime example on how CP can impact your life on a daily basis.

Try to be organized & honest, get a feel for the staff, other patients & of course the doctor. At times you can tell alot just by observing.
My PMs office for the most part has happy understanding staff who treats the patients with respect & it says they work for pretty nice doctors. The patients interact with the staff on a very positive, friendly level.

Sorry this is kind of last minute but hope this helps. I wish you the best of luck & if possable let us know how it goes. Good luck, Sammy

 
Old 01-26-2010, 11:17 PM   #3
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Re: Advice when talking to pain management doc for first time?

Sammy has given you some great advice all the way around. I just wanted to echo what she said about not mentioning the addiction & etc. Many in PM today are on the edge of their seat already. I wouldn't give them anything that could be perceived wrong....Especially at a first appointment. While your intentions are good, it may backfire and ultimately hurt your need for effective treatment.

Overall, I would try to stress how the pain effects your life and how it impacts you daily. I would explain in detail what happens while you are at work, and how you cope at home.....Especially the part about your "dead day." I would also tell him about the letter your friend wrote and how others apparently see you much differently than you see yourself....That you haven't realized exactly how moody you have been....And it's due to the pain.

Best of luck at your appointment.

Regards,

Ex

 
Old 01-27-2010, 08:04 AM   #4
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Re: Advice when talking to pain management doc for first time?

Thank you both for your help. I appreciate it immensely. I am going to write those things down today and make sure I take it with me. It makes sense that I dont tell him about my family tendencies, if I have been on things for a while and not had an issue, then it shouldnt me an issue anymore. (But I will be evervigilant in that regard, believe me). I just hate the fact that I am not me anymore, I feel more ***** than the nice person I used to be. No more patience of which I used to have an abundance, etc.

Thanks again,
CS7

 
Old 01-27-2010, 08:54 AM   #5
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Re: Advice when talking to pain management doc for first time?

Good Luck CS7, and I think we all feel the same way, that we're not the same people we used to be. Don't feel you're alone in that you're not.

 
Old 01-27-2010, 07:05 PM   #6
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Re: Advice when talking to pain management doc for first time?

Hello CS7,
I agree with the previous two posters who said to hold off on talking about the addiction issues in your family. I've had that backfire on me, talking about it too soon.
It sounds like you have a head on your shoulder and that you're going about this in a logical, systematic manner. I know that my doctor asks me what it looks like when I'm in pain. Think that one through, it sounds like you have a good start on it.
One of the things I do is keep a pain journal, listing the pain, time of day, scale of 1 to 10 rating, what makes the pain worse, and better, well, you get the idea. I would put the first entry on paper and have it with your other notes. It will show that you have a plan.
Doctor's use data to make their decisions. The letter from your friend, while difficult to read, is a good hard piece of data.
Hold your head high, know that your pain is real, and that you deserve to get the help that you need. Know that you're asking to get your old self back, that you're not aiming for something unattainable, or unrealistic.
Life with chronic pain stinks.
Let us know how it goes and how we can help.
Peggy

 
Old 01-27-2010, 07:10 PM   #7
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Re: Advice when talking to pain management doc for first time?

Excellent idea about the pain journal, I forgot about that. I did it too. It's a good way for the doctor to see how much pain you're in because when you get there you'll forget.

 
Old 01-27-2010, 10:30 PM   #8
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Re: Advice when talking to pain management doc for first time?

Quote:
Originally Posted by Pegala View Post
One of the things I do is keep a pain journal, listing the pain, time of day, scale of 1 to 10 rating, what makes the pain worse, and better, well, you get the idea. I would put the first entry on paper and have it with your other notes. It will show that you have a plan.
Peggy is right...A pain journal would be a great idea....If nothing else, just show what times of day, the pattern of your pain, diet considerations, and etc. You never know....You may uncover something really beneficial.

I also wanted to discuss the pain scale, because it's probably something that you'll be asked to fill out. Good congruency on the pain scale is critical. One of the biggest mistakes CPers make, is not adequately communicating their pain. PMs use a scale of 1-10 and will put a lot of emphasis on this rating as to decisions they make re: possible treatment plans.

The pain scale, working backwards:
  • A "10" is the worse pain imaginable. Most people have never experienced a 10, so Docs wouldn't take someone serious if they report a lot of 10s.
  • "9" is very serious pain...Something like post surgical or very debilitating type pain that makes one bed ridden.
  • "8" is very serious pain that causes one to miss work or school and requires serious medication. Physical activity is seriously limited. Even reading can be difficult.
  • A "7" is bad pain, but some may try to go to work or school, but may not accomplish much and discomfort level is high. 7s cause mood fluctuations and the pain is very bothersome.
  • "6"s are where the pain starts to get serious IMHO, and can cause disruptions in people's lives. Pain at 6 and above can cause mood swings, absenteeism, and is a general nuisance.
  • "5" is where many professionals will define pain as being "distracting." Most PMs will set an expectation that severe chronic pain can be acceptable around a "4" or "5"....Many will say that one should be able to live with pain around this area.
  • Most PMs will consider pain below 5 as minor in nature and may not require PM intervention. A lot of pain below 5 can either be handled by a GP, or OTC meds.

The above is by no means the gospel. However, I would say it does a pretty good job of describing pain in general. Again, one of the biggest mistakes CPer make is not correctly assessing their pain. Most patients underestimate their pain, thus causing under treatment. However, it's equally important that one doesn't overstate their pain either, or you may not be taken seriously. For example, if you're joking around with the Doc about something that was on the news, or last nights American Idol show, chances are you don't have an "8" or "9." If you don't communicate your pain correctly, the PM won't be able to help you as much as he/she would otherwise.

Lastly, some PMs will use a 1-10 scale and have pictures of faces corresponding to each #. This should be considered nearly identical to what I just outlined.

Best of luck at your appointment.

Regards,

Ex

 
Old 01-28-2010, 05:45 AM   #9
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Re: Advice when talking to pain management doc for first time?

executor,
When I go into my PM, the first thing they'll ask me is how my pain is that day. My answer is usually "with the meds, I'm at a 2 or 3", which is true. My pain is now under control for the first time in years. To the point where I can live without it being on the top of my mind at all times. That's an OK answer right?

 
Old 01-28-2010, 05:54 AM   #10
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Re: Advice when talking to pain management doc for first time?

I would think that was extremly helpful Ex. My PM uses the pain scale often. I hate it to be honest as my pain can be all over the place. I dont hesitate to put down alittle note to explain something better.

I learned what used to be an 8 is now a 7, hard to explain but at times one learns to adapt to pain or experiances worse. I never put down a ten. Ten is when Im in ER & can barely comprehend or speak due to the pain.
Most of the time when my pain keeps me back its a 7, 8 is when Im off my feet, 9 is heading into the doctors or ER. You have to consider to just living with 5,6,7s is exhausting day after day. Its easier to use numbers at times when describing a day, You may start out with a 7 then after meds it may become a 4 or 5 & then after activities back to a 7. Something like that.

Anyway great advice from everyone. Ive kept journals or diarys & Ive looked back just to see what was going on when a new symptom started. They can come in handy for your personal use.
I think we will all be thinking about you & Im curious to see how this appointment goes. Sammy

 
Old 01-28-2010, 08:29 AM   #11
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Re: Advice when talking to pain management doc for first time?

Quote:
Originally Posted by dmarcus48 View Post
executor,
When I go into my PM, the first thing they'll ask me is how my pain is that day. My answer is usually "with the meds, I'm at a 2 or 3", which is true. My pain is now under control for the first time in years. To the point where I can live without it being on the top of my mind at all times. That's an OK answer right?
DMarcus- If this has been how you've been rating your pain and your Doc responds accordingly....And you're at a good place now, then I wouldn't worry one bit. My post was mainly directed at those who aren't getting the care they desire / need....It could be pain scale related.

The two most popular pain scales used are the "numeric" scale and Wong-Baker "Faces" scale. On the numeric scale, a 2 or 3 is considered "mild" pain. At 4, "moderate" pain begins. On the faces scale, and 2-3 is "hurts a little bit." 4 is "hurts little more."

http://painconsortium.nih.gov/pain_scales/NumericRatingScale.pdf

http://painconsortium.nih.gov/pain_scales/Wong-Baker_Faces.pdf

Hope this answers your question.

Regards,

Ex

 
Old 01-29-2010, 10:41 AM   #12
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Re: Advice when talking to pain management doc for first time?

Thanks to all for your great advice.

My appt with the nem PM doc was great! I FINALLY felt that someone was listening to me and not shutting me off when I mentioned pain. First I saw the NP and she took down all the information. I explained it all to her, everything I said before, about the 'emotional outburst' thing and she understood. They were appauled at my other doc (VA) who wouldnt give me any more than they did. She doubled the meds I have so now I can actually take the meds when I need them and not try to save them in case I needed them worse on another day (I was prescribed 2 lortab a day and 1 flexeril a day). She gave me 4 lortab/day and 3 flexeril/day, plus naproxen (which I havent tried before). So at least I know I can take a pill without worrying that I need to save it in case I hurt more another day.

I was so stressed before I saw them that when the nurse took my vitals, my bp was 177/80. thats the highest I have EVER been! She also wants to do some injections in my back which should be interesting.

I felt soooo much better after I left, like there was a bit of hope, ya know??

Well, anyway thank you all for

 
Old 01-29-2010, 10:30 PM   #13
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Re: Advice when talking to pain management doc for first time?

I'm very happy to hear that it went well for you. Great job!

Hope you start to feel better.

Regards,

Ex

 
Old 02-02-2010, 01:33 AM   #14
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Re: Advice when talking to pain management doc for first time?

well just get used to being judged-if you dont keep your pain mgt business to yourself. but anyhow any good pain mngt dr is aware the we who are really suffering are getting a bad rep due all the druggies.
if you are genuinly suffering that pain mngt specialist will know. just be real with him/her. there are realy well trained compassionate pain specialists out there-good luck

 
Old 02-02-2010, 01:36 AM   #15
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Re: Advice when talking to pain management doc for first time?

please tell how your pain became controlled. thanks

 
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