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Old 04-27-2010, 02:24 PM   #1
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Pain Dr switch? Not sure what to do . . . .

I have been seeing a pain management doctor for about a year for my RSD/CRPS. Currently I am prescribed oxycodone, amitriptyline, and skelaxin. I have been having very uneven pain control, especially in the evenings when things skyrocket. Since the oxycodone is short acting, I have been having pretty severe ups and downs too. A few months back we tried ms contin, but I couldn't tolerate it very well, so after about 1 1/2 months we went back to the oxycodone. I would really like to try another long acting med, anything that will even things out a little and then have some breakthough for when the pain gets really bad. Currently I have to ration out my meds to plan on even going to the store or walking my dog because the extra pain will be too much. I spoke with my doctor at my last appt about trying something long acting, but he said he thought we should try the spinal cord stimulator first before he wanted to try any other meds. After a quick google search I found out that my pain clinic has defaulted on their small business loan and have a judgement against them (within the last 3 months). I feel that is why they are pushing more invasive expensive procedures on me. I would change doctors . . . . But I am getting married at the end of the year and my insurance will be changing, so I'll have to switch doctors anyways I am trying to decide if it's worth it to wait it out, or just switch now and hope it doesn't look badly on me for jumping around. I have tried everything I have been offered, and found some other treatments on my own. I've tried a bunch of nsaids, ibuproferen, tramodol, neurontin, lyrica, cymbalta, compounded creams, biofeedback, nerve block injections, tens unit, infrared light therapy, physical therapy, etc . . . . . Some have been helpful to some degree, while others not so much. I just don't understand why he won't try anything else until I do the SCS . . . . It's very invasive and I also see a Pysiatrist and he is dead set against me having the procedure. Both of these doctors dislike the other's methods, and occasionally will bad mouth each other. When my pain dr told me that he didn't want to try any other meds until I do the scs, I told him I was hesitent to go that route because of the cost (once my insurance changes it will be much cheaper), the risks, and the down time. He refutted every one of my statements, telling me my other doctor was telling me that stuff to scare me. But when I looked on the medtronics website it confirmed everything, and I had the pain drs office call my insurance to get a rough estimate of my cost, and yeah, it's insane!

I'm not sure what to do - Right now I'm barely making it through the day, and thats with hardly any activity at all, which I know is a cardinal sin with RSD/CRPS. You have to keep the affected areas moving, but it's really hard when I'm in so much pain. My pysiatrist would take over my meds, but he doesn't believe in treating pain with opiods, and would taper me off immediatly.

What do you all think? Should I start looking for another doctor even though I'll have to get a new one at the end of the year? It's still a good 6 months away, so I'm leaning towards finding another dr. But I don't want to look like I'm jumping around . . . .

 
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Old 04-28-2010, 10:10 AM   #2
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Re: Pain Dr switch? Not sure what to do . . . .

Just because you find a new doctor doesn't mean that you will have to change when you get new insurance. Alot of doctors participate in more than one insurance plan. It's the only way they can stay in business. Personally, I would find a new doctor that doesn't have a lien against them. That's bad business practice, and definitely a reason to leave a clinic-especially if your doctors is one of the main members. Just be honest when you find a new doctor. Tell him that the previous clinic had deaulted on a loan blah blah blah..and you aren't comfortable with being in that type of clinic.

Usually the pumps are put in as a last resort, not as a first resort. They aren't little things that you just drop in place. If you read Shoreline's posts you will see that it took months for him to get regulated on his pump. I'm surprised your doc is pushing it first...

Good luck and you can find a new doctor..........

 
Old 04-28-2010, 10:28 AM   #3
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Re: Pain Dr switch? Not sure what to do . . . .

Thanks My new insurance will be Kaiser . . . . So that makes it impossible to find a doc now that I'll be able to keep after the switch (unless I want to pay cash). It will have to be a complete switch The only doctor I've found so far that will accept both insurances is my current one, and that is only if I have a certain Kaiser plan that allows me to go to outside drs.

I thought it was rather "soon" to be pushing very invasive stuff. The only LA med I've been on is the ms contin, and that was only for a short while because I couldn't tolerate it. And I've only had rsd/crps for less then a year. It was funny, at the last appt I asked my dr about going on the patch (because of the level of pain I've been having I throw up a lot when things get bad, so it's hard to keep oral meds down). He seemed to think that was too drastic of a step! I'm taking about 75mg of oxycodone a day, so I don't see it the same way.

And when I google his name and the patch, I found several articles about a high school football player in my area that hurt himself, abused his meds, then went to my clinic and they put him on the patch. It's strange to me that admitted abusers can get long acting pain control, but I can't? This article started out with the kids story, and about how he started abusing meds, then went in and out of rehab several times, the kid calls himself "addicted to pain meds" but the quote from my doctor says "absolutly not!" and goes on to say there is a difference between addiction and dependence. He explains it correctly, but in my opinion someone that admittedly doctor shopped, used their meds incorrectly, bought on the streets, etc, is addicted, not just dependant. Dependancy to me means that your body is used to it and needs it to function normally, dependence doesn't mean to me that you are out on the streets looking to score.

 
Old 04-28-2010, 10:31 AM   #4
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Re: Pain Dr switch? Not sure what to do . . . .

Oh, and this doctor is the clinic, he is a one man practice.

 
Old 04-28-2010, 02:04 PM   #5
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Re: Pain Dr switch? Not sure what to do . . . .

Hey Goudag24,
I'm with ibake&pray. It is highly unusual to go to implanted devices before trying long acting meds.

 
Old 04-28-2010, 02:33 PM   #6
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Re: Pain Dr switch? Not sure what to do . . . .

So my dr is off when he says he doesn't want to try anything else? When I had this discussion with him, at the end he mentioned that if he could, his choice to try would be nucynta(sp) . . . . But that my insurance won't cover it and he already tried with another patient under my insurance to no avail. I just don't understand how 1 trial with ms contin and nothing else would warrant the jump to implants. He also told me about how long acting medicine keeps a contstant amount in my system, where with the sa's it's not like that, but I'm taking 5 15mg's a day, and have been for almost a year, so it's not like I'm making a big jump here. He's also told me he doesn't want me to take more then 5 pills a day, when I've told him that the pain was not covered, he would up my mg's. Then in the waiting room I see a guy come in and tell the receptionist that his insurance wouldn't cover the 450 pills in his monthly script, so he would have to come back sooner. That's like 15 pills a day!

It just seems to me like la meds are the way to go right now. I keep a pain journal, take all my doses as scheduled, and follow all the rules to a T. I don't know if there is anything else I can say or do to convince my doctor to let me try something else at this point

Does anyone have any experience with Kaiser? I've looked through a bunch of threads here and didn't find much good to be said . . . . If it comes down to it I can choose another insurance carrier, but my fiancee prefers Kaiser because that is where his docs are, and since I'm looking for a switch and he has a pcp that used to be an rsd research doc.

 
Old 04-28-2010, 03:33 PM   #7
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Re: Pain Dr switch? Not sure what to do . . . .

Hey Goudag- Welcome to the boards!

I have to agree with the others about jumping right to this invasive procedure. It sounds kind of hinky to me. I mean seriously, he tried you on ONE long acting medication and is ready to throw in the towel and do an implanted device?? There are so many other LA meds out there that aren't the patch if he's so against the patch!! I mean, I know there aren't hundreds of other LA meds, but there IS more than just MS Contin!

Also, that loan default? That would make me nervous about getting an unpleasant suprise when it came time for my next appointment. I'd be afraid I'd go for my appointment to find the doors locked and the place shut down with no prior notice, leaving me to scramble to find a doctor who would be willing to take over my care (all the while suffering severe withdrawls).

Have you ran a check with your state's medical board on his license? If not, I'd do that and make sure there aren't any possible actions against him. If you find actions against him, run-do not walk- to another reputable PM doctor. Even speak with your PCP and see if he/she can help treat you while you look for another doctor willing to accept you and your insurance. There are many PM doctors who will not accept cash payment.

I really hope you are able to get this ironed out. Please keep us informed.

 
Old 04-28-2010, 03:45 PM   #8
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Re: Pain Dr switch? Not sure what to do . . . .

Ibake&pray is absolutely right!!

Good post


Bullymom

 
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