Im trying to find a pain management doctor, and its way harder than i thought. I have some bad discs that cause me alot of back pain, and i have to continue to work, in a somewhat strenuous job. I dont have a choice. The pain also affects my ability to function as a mom, a single widowed mom. I have to be able to do things in life.
I went to see a new pain man. specialist and i just was very disappointed with the options he gave me. I've had two epidurals before with no relief. The doctor told me my pain was chronic, not going to be fixed, i know this. Well he suggested he do another epidural but slightly different. At any rate, before that could even get scheduled etc. we discussed medication options. He ended up perscribing me baclofen for spasms, topamax for the pain(which i told him i've taken before for other reasons and didnt like its side effects, and percocet- 1 5/325mg every 6 hr as needed. HUH. See this is where the problem occurs. Please dont judge, but i have a high tolerance for pain meds. I have taken Percocet before for back problems, but 1 every 6 hours doesnt even touch my pain. And i told him this. I know this is where the doctor doesnt like to be told what to do, blah blah etc but i just wanted him to listen to me. I acknowledged the fact that the combination of the meds may work better but... He didnt budge. So i have been trying his regimen and no way is it even touching me. I called and ill have to wait to be seen blah blah. I just dont understand how its like you go to a PAIN SPECIALIST and you walk out and have another 30 days in pain. Now im ambivalent because i dont think he listened or cared to really listen to me. I really thought he would have perscribed me something long acting with a short acting for as needed in between. what he gave me is more for BT pain. Even 10mg would have been a lil better.
At any rate, I need advice. i have heard it may take awhile to find the right doctor, the one that clicks with you. Do I just go and make a new appt with another PM or what? Sorry so long, I've just been in pain a long time and finally got the appt and now this.
I can only suggest that you keep looking; it's frustrating on so many levels but there really is nothing else to do. There are some doctors who use good, common sense and don't underprescribe. One of the problems is that there is so much money to be made in doing procedures and injections, and not so much in just prescribing meds. One can only keep on trying until we finally get lucky.
Have you seen a spine specialist yet? If not, that is another route to pursue. A definitive diagnosis can help a good pm know just what you might need both in the way of procedures as well as pain meds. Have you had any surgery? I assume you have had an MRI at some point that disclosed your problems but without knowing the results, I would be hard pressed to make any other suggestions. I do know that my spine specialist (an ortho with a fellowship who devotes his practice to the spine only) also prescribes my pain meds and has never hesitated to give me what he thinks will help, while my pm doesn't believe in pain meds for a person like me who has a pain pump.
Please let me know if there is any way I can be of further help.
Lumbar surgery x 7 over the last 30 years.
cervical fusion...2 levels
medtronic pain pump implanted
Last surgery Oct, 2010, 3 levels
Last edited by Administrator; 07-04-2011 at 01:22 AM.
The following user gives a hug of support to maltluver: starlet66 (07-03-2011)
I know that it may be frustrating but you have to remember, you are a brand new patient to this practice, this doctor. He doesn't know you from adam, and it is going to take time for him to establish some level of trust , just as it will for you to come to trust him as well.
As far as him starting you on a long acting pain medication goes, or a higher mg. short acting medication, that is not going to happen, no matter how many doctors you see.
First, do you have a confirmable diagnosis? MRI's, xrays, emg results, CT scans, etc to prove the problems with your back. Medical notes and reports from previous back surgeon's or GP's that you have seen? Most PM doctors will not even consider prescribing pain medications until they do have those previous records and studies/reports confirming the diagnosis.
There is a standard of care that they should follow with any patient- PT, TENS, other non opiate medications, injections, then maybe opiate short acting medications.
It would be completely unsafe and irresponsible for any doctor to give a patient without a confirmed opiate tolerance a long acting opiate medication or even a stronger mg without knowing that the patient is tolerant to them first. Overdoses and death occur daily even in patients who are opiod tolerant , and with the rules of the DEA regarding the prescribing of opiate medications, they are even more careful with patients than they were before. Otherwise their licenses and income can be put in serious jeapordy.
I know that wanting pain relief sometimes can overshadow our understanding of why things are as they are, but we as patients have to have some understanding of the rules of pain management and build a relationship of trust with our doctors so that they are comfortable in prescribing adequate medication to reduce the amount of pain, without over medicating.
You have to give each new medication, each dosage increase a fair amount of time to see how it is going to work, or if it is going to not work- ie a few weeks or a month is better , before deciding that something is or is not working, unless you are allergic to it, or the side effects are so severe that your body can not tolerate the medication. Other than those things, try using ice, heat, over the counter pain patches, massage , stretching and a hot shower will do wonders to work with the medications to help ease the pain.
The patient that isn't satisfied with their level of relief is going to be judged by the doc that's presently treating them, Meaning, you have pain, you have all these problems and you told me that you were taking advil when you got here. If that was the case, any relief should be appreciated and he's going to watch to see how you follow his last instructions despite your concerns. If you go back in 30 days and tell him you have been out for 2 weeks, Why should he believe that you would treat 30 mg Roxicodone every 4 hours any differently if you felt justified by pain. Meaning patients don't suddenly become compliant when their needs are met. If this were the case, as soon as you develop some tolerance, you will run out early again and at that point most docs will discharge you and you have to start over.
As far as simply accepting opiates from this guy and moving on to the next doc that will prescribe larger and stronger doses, It doesn't take much to get flagged and potentially prosecuted for doc shopping, It's hard to take care of kids while in jail. That is what you would be doing. if you find another doc next week to treat your back pain with a stronger med. You have to at least try what they suggest to avoid the appearence of <doctor hopping>.
Antoher question I have is what are your expectations, You dont sound too flexable as far as changing jobs, making lifestyle changes or doin much more than looking for the right dose of meds for the day. It would be easy to take offense to those who write they have too much responsability or have physical jobs and can't aford to take time off or have surgery or certainly apply for disability. When someone is disabled, It's not a choice, money, children, the mortgage have nothing to do with ones ability to function, walk or stand. If you can't walk or stand more than 20 minutes, work ethic and responsabilities don't factor into the equation. If it means selling your home and downsizing, that's what you do to survive.
Ive had docs that wouldnt prescribe a single vicodin tell me if you can sell pencils sitting on a bench in the park then you can work and aren't disabled. Widowed single mom is sad, but it's not a medical condition that requies the use of the most abused drugs in the country and doesn't mean that you shouldn't have to do your part which may mean find a less strenous line of work even if it means less money. Loose weight, excercise daily, and basically do your part. When common sense says change jobs to avoid being dependent on pain meds the rest of your life, maybe it's time for good old fashion common sense.
Last edited by Administrator; 07-04-2011 at 01:28 AM.
i agree with the others on this issue...
first thing i would do, is keep a pain diary.. also make a list of pain medications (whether they are non-narcotic, narcotic, ainti-inflammatory, muscle relaxers, nerve pain meds and any others) that you have tried in the past, with the most recent at the top of the list- along with what kind of relief you got from them & any side effects you had...if the most recent is no longer working for you, or very little relief or side effects-- ask the doctor what other options are there in re of meds that he feels would help..
i would not ask about any "pain medication" by name, especially the narcotics.. even ask about what type of topical pain relievers are available, they will often give you samples to try as well as a script to fill if they help you..
myself, i am looking for a new pain management dr myself.. now figure this one out.. from day one my pd offered me a narcotic and i told him no, not as long as the medication i was taking was working and the dosage could be increased. after a year with this dr the darvocet was pulled off market, and i had no choice but to get a replacement. first thing he threw out was a high dosage of lortab ( had that years ago after a surgery & it was too much for my system), so i asked that he start me on the lowest dosage available and increase as needed- which he did... mind you this was for "breakthru pain" that the tramadol did not relieve. i told him i would not have to take them every day, as i did not have the breakthru pain every day. he would only give me a 15 day supply @ 2 per day. i had to go back every 2 weeks for updates and refills. at the visit for refill #3, he asked when was the last time i took one & it had been 3-4 days. he did a urine test & gave me a refill for 1 per day for 15 days. when i went back 2 weeks later, he said my urine test was negative (which he knew it would be before he did it, cause it had been 3-4 days since i had taken one), and he could no longer prescribe me any type of narcotic pain medication- this is noted in his office notes.
last time i saw him in early may, i was asking him about my other meds, and if there was anything other than tramadol that is not a narcotic, he was rude and said "no, there is not. and i can not give you any narcotics any longer, so if you need those you will have to get them somewhere else"... so i have not been back to him as yet.
point being, you can mess yourself up by asking for meds by name, and also for not taking them exactly as prescribed (even if you do not need them as prescribed)...
ok, till you find a new doctor ask this one to rx you gabapentin + diazepam(valium) and if he refuse to prescribe you diazepam ask for clonazepam. It will give you relief till you find a doctor who will prescribe you narcotic.
I was on baclofen - it did nothing.
That is what I do: I take diazepam10mg x2 a day(morning and afternoon)and in the morning I take gabapentin one pill 400mg and at 6:00pm and the next dose one pill 400mg at 7:00pm. Then first time since the accident I can sleep and function.
I also have oxycontin 40mg, but prefer not to take it every day.
Honestly, first time since the accident I am able to sleep 7-8 hours.
Are you able to sleep?