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Old 04-19-2012, 09:54 PM   #1
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Rude PMS... normal?

Hello everyone, I’m new here and looking for advise.

I had surgery for a 1 ½ inch tear in my rotator cuff. My surgeon told me the surgery may or may not work, since the tear was so large. This was three years ago. I have been on pain meds 2 years prior to the surgery, and every day since.

There is no option for another surgery, and the pain is so great it affects my everyday life in many ways, from getting ready for work in the morning, to doing my job in the office. (Hard to do much when I can’t lift my right arm above shoulder height)

My primary care physician sent me to a pain management Dr two months ago. My first visit went ok, and I was surprised when he increased the vicodin I was taking from 5/500, to 7.5.

On my second visit, he gave me a steroid injection and began scolding me, stating that other Dr’s might keep me on pain medications but he would not. That if surgery wasn’t an option, that I need to learn how to live with the pain.

I was shocked and humiliated by his behavior towards me. I told him that I didn’t seek him out, that my Dr. referred me to him for help.

I left his office stunned, with a refill for my medication and another appointment in one month. I don't know if I ever want to go back!

I guess my question is, has anyone else been treated like this? Is this the norm for a PMS? I honestly have never felt so belittled by someone I was paying to help me.

Thanks in advance

I'm wondering if there are others that are treated like this when they go to their Pain Management DR. Would you put up with this sort of treatment? If not, what would you say to the Dr who spoke to you like this Dr spoke to me?

Last edited by mia93618; 04-20-2012 at 12:35 PM. Reason: Maybe I'm not asking the right question?

 
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Old 04-20-2012, 02:14 PM   #2
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Re: Rude PMS...normal?

Hi Mia,
To answer your question regarding whether or not I would put up with someone who spoke to me that way, the answer is a resounding no.
I don't know how much you know about PM treatment but I always view my relationship with my PM as a partnership. I pay him to help me find ways to manage the pain levels so that I can function as best I can, and I need his expertise to do so, as well as the many modalities he has available to him to help me that I can't get on my own. My part of our relationship requires me to be honest with him about my pain levels, what other things that I am doing to help ease the pain aside from medications, and following the rules of his practice.
Many times , people new to the field, believe that PM means that they will be painfree, but that's not what pain management is- it is using many different modalities to find the best ways to reduce the pain levels. A realistic goal is one that allows the person to function in the activities of daily living, while keeping the pain levels at a point that allows the person to function with a minor amount of residual pain. If you tell the doctor that your pain levels are consistantly a 7-8, then the goal of your PM should be to hopefully reduce those levels to somewhere between a 3-5. This would allow you to work , and perform most of your household duties. It means PT, if recommended, sometimes injections into the effected area, OT , massage, ice, heat, TENS, sometimes implanting a spinal cord stimulator for back patients, and exploring other options as part of the treatment plan.
You also have to remember that while the PM is giving you opiates at this point, it may not always be the best option when it comes to treating your type of chronic pain, so he may also recommend muscle relaxers, neuro type meds that help reduce the signals of pain sent through the nerves, anti depressants used off label have often been found to be really helpful in managing pain so you may see some of those types of meds added to your arsenal of pain management as time goes on.
Sometimes , new patients when meeting with the PM doctor have expectations that are a bit unrealistic, and I'm not saying that is what happened in your case, but some PM doctors can try a bit too hard to impress on a patient that opiates are not the only means available for managing pain and that a certain level of pain is something that they are going to have to learn to live with given their medical condition, unfortunately, it can come out all wrong when in the office setting. I think that if I were you, I would give the PM another chance and talk to him about what your goals are for pain management and find out what his are for his treatment of you.....if you still feel not heard after that,then I would consider trying to find another PM doctor.
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Old 04-20-2012, 09:57 PM   #3
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Re: Rude PMS...normal?

I have had this happen to me. However, I have not put up with it. I'd never have someone take over my pain meds until I had a visit or two with them to get an idea for what their treatment plan was. Sounds like they led you on with the dose increase then changed their mind or something? I would be looking for a different clinic, but keep getting your meds from there until you have something in place. Interview a doctor without actually switching (or cancelling any contract you have with the old place or signing one with a new place).

I think trying a patient on any available non-narcotic treatment is imperative. But, to say that a patient can't be on pain meds if nothing else works in the long term is ridiculous. Plenty of patients are, as it improves their quality of life. It isn't anything to take lightly though. I would want to be plenty sure from multiple opinions that nothing could be done surgically, injections, pt, massage, etc. Yes you need to learn to live with the pain, but that is often an adjunct to the medication management. They should be referring you to a psychologist, cognitive behavior specialist, biofeedback sessions, etc, not lecturing.

I do give doctors a lot of slack in general. Think about how many patients they see in one day. Most of them come in complaining of pain and there honestly isn't too much they can do for a lot of them besides write escalating prescriptions. When you get to patient 20 at 4pm, you might get a bit short. I'd see if this was a one time thing while exploring other options. As long as you don't get meds anywhere else, that doesn't generally violate any typical contract (but always be aware of what you may have signed). Best wishes.

 
Old 04-21-2012, 01:02 PM   #4
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Re: Rude PMS...normal?

Most likely everyone who's been in Pain Management for any length of time has had a Doc like this. PM docs can be tough to deal with. When you think about it, it makes sense, probably half of their patients are drug addicts, looking for a fix. That leaves those of us who really need meds to control our pain, holding the bag and having to deal with Docs who are governed by the DEA, and are irritated from dealing with drug seeking patients. Is it right? No. Is it understandable? yeah probably.

A good PM doc is hard to find, and they're kind of like psychiatrists, you have to look around until you find one that's a good fit. I've been in pain management for 25 years now, been through countless Dr.'s, PM specialists and surgeons and plenty of them have been jerks. But there have been good ones in the mix too. My current doc is awesome and I've been with her for 13 years now. She works with my surgeons, (I've had 26 surgeries in the last 13 years)and takes care of my pain management. When you find a good Dr., do whatever you have to, to keep that Dr. Because lord knows the good ones are few and far between.

Good Luck,

Kat

 
Old 04-21-2012, 05:18 PM   #5
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Re: Rude PMS... normal?

GI Docs are also a nasty bunch of Doctors.... We have one in the family and she told me that her Colitis/Crohns and post surgical patients were all 'whiners'... Gee (gulp) thanks, lol.

Last month I too tore my rotator cuff, a longitudinal tear with delamination, degenerative changes, debris, blah, blah. The arm felt like a dead throbbing piece of gristle..... Well, I had to refuse the Ortho's offer of pain meds because I'm already ON pain meds for the above mentioned GI conditions and they barely do anything for that or the shoulder. He suggested we start with a PT to get it unfrozen since I walked around with it tucked to my side for a few weeks first. Now it feels fine. 25 years of GI docs and not once was I offered any pain meds, and when I finally inquired about them a few years ago I was quickly shut down on that subject. I had to go around my GI guy to my PCP.

 
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