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Old 05-07-2011, 05:01 PM   #1
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How to go to pain clinic, get meds, etc. Other doctors won't take me seriously?

I have never been to a pain clinic before.

Last year when I was 18, I was in a car wreck but I felt fine at the time. But then I started experiences some soreness in my lower back after awhile. Since it was only once in a blue moon, I ignored it. I didn't mind a little pain now and again, it happens to everyone, right? Well then I was at work a couple weeks later and I was working with stock, and I picked up a heavy box, twisted my back slightly, and tossed it to the side. I think the way I twisted my back when I threw that box messed up my back because it hurt like hell all night. Ever since then, whenever I lay flat (like when I'm laying in bed) I feel a ton of pain right in my lower back where my spine bends. No matter which way I lay, the pain hurts so badly and only gets worse the longer I lay there. It even wakes me up at night on occasion.

I've seen a couple doctors about it, and they don't take me seriously at all. They get rude with me and think I'm some junkie just wanting to score some pain meds. While it's true I think pain meds would be helpful (after all, I'd only be taking them when I go to bed- what, do they expect me to be getting high while I'm sleeping?!), I'm not a drug person. I just want to have a painless, full night of sleep. They try to tell me things like 'oh, buy a new mattress' and 'well maybe you should try going to the gym and working out' but I've bought a new mattress, a layer of memory foam, AND I go to the gym 2 to 3 times a week and nothing has changed.
There was one doctor who didn't want to prescribe me sleeping pills, but told me to buy over-the-counter medicine that is apparently allergy medication, that makes people sleepy, hoping then I could sleep through the night. I tried it, still, it didn't work. I would still wake up with pain.

So, my questions are:

1) How does one go about going to a pain clinic? Just give them a phone call and make an appointment?

2) Do I need a doctor recommendation? Since the doctors I saw were of no help to me and didn't take me seriously, I doubt they would give me a recommendation.

3) Are they just walk-in, walk-out clinics? The closest one is a couple hours away, I can't afford to drive up there multiple times a month to "Check in" or do some classes or special training or anything like that.

4) If we do talk about pain meds (which I'm hoping for), what else can they prescribe besides vicodin? I took it once and although it made my pain diminish a bit, it made me feel paranoid and anxious.

Thanks for all your help!

 
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Old 05-08-2011, 09:24 AM   #2
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Re: How to go to pain clinic, get meds, etc. Other doctors won't take me seriously?

Rainboots,

First off let me tell you that you are going to face an up hill battle just because of your age alone. Most doctors are very hesitant to give someone of your age strong narcotics just because of all of the abusers and pill poppers out there. I'm not saying that you are but just be very aware of that. Read through some of the past posts and see the difficulties that some of us with chronic well documented pain have had.

Here is where I would start if I were you. I don't know if you have health insurance or not but I would strongly suggest that you find a way to get it. Someone with no insurance complaining of general back pain asking for meds is an automatic red flag. You need to start with a family doctor who will most likely give you some steroids (dose pack) and muscle relaxers and maybe some vicodin. Don't expect alot and be happy with what you get. Take them EXACTLY as prescribed. The family doc will probably do xrays and may send you out for an MRI. This is the documentation that you will need.

Once the family doc sees that there is a genuine problem, he will most likely send you out for physical therapy and then pain management. Pain management will want to do epidural injections to alleviate some of the pain. I would do some research on the internet about some of the injections and other types of pain managment that they will try so you have an idea of what to expect. The doctors will want to try all of the conservative measures before referring you to a surgeon.

Now why did I tell you all that. You will need consistancy with your doctors for them to begin to trust you and see that you have a genuine problem. If you abuse their trust they will drop you like a bad habit faster than you can believe it. Also if you refuse thier treatments they will most likely think that you are just there for the meds and again drop you.

Now getting to your questions. If you have insurance, you will definatley need a referral from your family doctor to pain management for the insurance to cover it. As for someone who is paying cash, I don't know but again you will face the same difficulties listed above. It is going to be insanely expensive too. Based on your income, you may want to start looking at Medicaid or other state assistance for insurance. If you are a student, your parents should be able to still cover you on their insurance.

As for asking for meds.... You have to be very carefull and tactfull about it. If you go in there demanding a certain type of med they most likely will not give it to you. Most doctors like to start with vicodin as far as opiates go. There is a ton of stronger stuff out there but your chances of getting it first off are very slim. If you had a negative experiance with vicodin then you need to express that in your history and tell them how long ago it was and how long you were on it.

You need to find a good family doctor that will listen to you and cares. Once you find him or her, you need to stick with them. If the doctors see that you are going from office to office or pain clinc to pain clinic then in their eyes you are "doctor shopping" and they will let you go.

I'm sorry Rainboots but I think you have a rocky road ahead of you to find help. Please keep the faith and get yourself on track to finding a GREAT doctor. Once you find a great family doctor everything else will be easier from there. They are the starting point.

Good luck,
"Joe"
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Old 05-08-2011, 01:17 PM   #3
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Re: How to go to pain clinic, get meds, etc. Other doctors won't take me seriously?

Hi Rainboots. Joe gave you some pretty straight forward sound advice. If your able to call a pain clinic and get in and get a script the same day, that pretty much means you found a pill mill where they will give anyone meds that has enough money.

The fact you haven't done any PT or tried anything else like steroids, chiro, acupuncture, or any other method to manage your pain means you have a long way to go before any legitimate doc is going to feel comfy prescribing opiates because you haven't tried all or any other method to manage pain.

As far as sleep, They don't use opiates for sleep. They use antidepressants that make you sleepy and also help with pain, or they use natural things like melatonin, benedryl or actual sleep meds with low abuse potential. The reason they dont use opiates for sleep is because of respiritory supression and meds used for sleep tend to become innefective or you become tolerant very rapidly. The expectation to be pain free and sleep 8 hours is for people that dont have pain issues.

I had my first back surgery in 93 and haven't had a pain free moment since and I haven't slept more than 3 hours straight in 10 years since the last 6 level fusion and I have an implanted pump that delivers dilaudid to my spine. At best it relieves 50 percent of the pain on a good day and that still leaves me disabled and unable to work a full time job.

There are also pain clinics that dont use opiates at all. They use other methods to manage pain. I went through 3 different month long, 8 hour a day programs and had 3 major spine surgeries over a span of 8 years. It wasnt untill I had a heart attack on my 36 Bday after living with intractable pain that kept my BP sky high for a decade before opiates were even offered to me.

Opiates are the last resort when nothing else works and you have no quality of life. Wanting 8 hours of sleep or to be completely pain free arent reasons to go to a pain clinic. Pain free isn't even a goal of pain management, If it was it would be called pain obliteration

Do the PT, Learn how to strengthen your core and back and all the other stretches and excercises that benefit the back and you may find it resolves all your problems. See a Chiro, try anything that might possibly work. As long as there are alternatives, expect to be asked to try them first. If you have a back that requires the use of opiates daily you should be excercising every day and doing all the things they teach you in PT. You will find what works for you and what doesn't. Im not suggesting continuing to do things that dont work. But in general, 3 times a week at the gym simply isn't enough to do more than maintain. You need to do more than maintain. You need to strengthen and do it safely, that's why you start with PT. When there is nothing more a PT can do for you, take what helped and put it to use daily and move on to the next modality, whether it's chiropractic or learning a relaxation technique like bio feedback, self hypnosis and guided imagry.

I get this web sight can make it seem like there is nothing more to pain management than pain meds, but that's not the case. You dont know the background and what other posters have been through or tried before getting to the point of seeing a PM doc or going to PM clinic. Like Joe said, you have a long way to go and I'm just trying to explain what some of those steps are.

There are also all the diagnostic tools I didn't hear mentioned, MRI, CT, Meylogram, Bone scan, Discogram. etc etc. Whats wrong with your back that you need Vicodin or something stronger.

Again, If some doc is willing to prescribe without investigating every possible cause of your pain he's most like a quack and shouldn't have the right to prescribe these meds that get so much bad press that the people that truly need these meds have to jump through amazing hoops just to have some quality of life. The clinic I go to now does pill counts at every apt, random UA's and we have contracts that spell out every rule and what do do in any situation. If the doc isn't coverng his a.., Most likely he wont be there down the road once you have become dependent on these meds.

BTW, even after having a pump implanted, I still work out and stretch daily or I dont feel like Im doing my part. I still use relaxation techniques i learned at those clinics to catch my breath when it hurts too much to breath. I still go in and have trigger point injections and nerve blocks done and still use steroids or get an epidural steroid injection when things are really bad. Opiates aren't a cure all and simply because they provide immediate relief, doesn't mean it's the best or only way to manage pain or discomfort long term. At best their part of a multi faceted aproach to dealing with severe chronic pain that hasn't responded to other treatments.

At worst, Their everything you read about in the paper and see TV reports regarding the abuse of prescription drugs. It doesn't take a genius to figure out what's going on when 80% of all OxyContin scripts are written in one state. Lots of quacks that are simply drug dealers with MD behind their name turning every day people into addicts that never had a valid reason to take the meds to begin with simply make it harder for the people that these meds truly improve quality of life for and restore function rather than deminish function.
Good luck, Dave

 
Old 05-08-2011, 08:00 PM   #4
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Re: How to go to pain clinic, get meds, etc. Other doctors won't take me seriously?

Honestly you may be jumping ahead a few steps. you may just need to go to a back dr. and see exactly what is going on with your back and what is causing the pain. This is goign to get you quicker results than just going to random dr.'s trying to get narcotics. Dr.'s aren't quick to RX narcotics for pain that has no documentation or actual diagnosis. And the chances of you getting into a pain management clinic without either of those is slim to none. Have you tried other types of pain management such as a chiropractor or massage? Really the first thing you need to do is see an orthopaedic or back Dr. and get a proper diagnosis, no one is going to take you seriously until you get that.

Kat

 
Old 05-09-2011, 04:34 AM   #5
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Re: How to go to pain clinic, get meds, etc. Other doctors won't take me seriously?

it is tougher than hell to get doctors to take a young person in pain seriously these days but dont let me discourage you! it took me ~8mos to find a good doctor although I'll admit some of those months I just gave up. and though I now get pain meds from the doctor I wish I didn't but I'm stuck between a rock and a hard place.

I' would try everything you can before resorting to narcotics/quasi-narcotics. benadryl & melatonin both help with sleep and can be found off the shelf and are both safe and are not detrimental to your health. valerian is another natural sleep aid & muscle relaxant that should help you sleep but I don't think you can find that in a pharmacy? check in a health food store or even online. I buy my homeopathics from a local health food store which has an amazing selection.

If your still having difficulties I would ask your doctor about flexeral which is a muscle relaxer and if your not used to taking it it makes you VERY sleepy! another possibility is valium which is a benzo which mainly treats anxiety but also relaxes muscles and should help you sleep, how ever like narcotics doctors don't like handing out benzos either.

I would also recommend seeing a chiropractor if you don't already. western medicine does not place enough value on a simple chiropractic adjustment.
good luck and let us know how you make out!

 
Old 05-10-2011, 07:41 AM   #6
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Re: How to go to pain clinic, get meds, etc. Other doctors won't take me seriously?

If I was you, rainboots, I would do an MRI. Demand it. You probably(I guess)have bulging or herniated disks. You cannot tell unless you do the MRI.

Then when the doctor see the sourse of the pain they have to rx you medication include narcotic.

WHat a nightmare I know. I also been in a car accident and cannot rest my neck on the pillow it hurts all the time in any give position.

 
Old 05-10-2011, 01:51 PM   #7
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Re: How to go to pain clinic, get meds, etc. Other doctors won't take me seriously?

WHEN YOU hadd the car acc there was ins involved, whose car were you in-if you were passenger and you have no car, then the Driver's ins is respons for medical bills. get an attorney consultation and tell them all of this-they will know how to proceed-but time is a wasting so do it asap!
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Old 05-18-2011, 10:15 AM   #8
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Re: How to go to pain clinic, get meds, etc. Other doctors won't take me seriously?

I'm sorry you are getting the run around on getting treatment for your back.

One thing I didn't see mentioned....

If you live in a state that has their opiate rx monitoring in place and you've gotten rxs from more than one doc and then turn up with an appointment with a pain doc....you run a huge risk that they will not take you for med management. This happened to someone I know. He filled a rx from a spine surgeon post op and later filled one from their pcp. He wasn't taking more than rx allowed. Pain referral was done later and the pain doc (my pain doc, in fact) would take them on as a patient, but NOT for meds, only for injections. The pain doc had checked with the state narcotics board and found out about the 2 doctors writing rxs and 2 different pharmacies. Fortunately, the injections/RF are helping a lot.

But it sounds more like you need a diagnosis of what's going on first and a primary care doc is where you should start.

 
Old 05-18-2011, 10:25 AM   #9
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Re: How to go to pain clinic, get meds, etc. Other doctors won't take me seriously?

Just an FYI, I've always gotten my Valerian Root at Rite Aid or Wal Mart.

 
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