I can relate to what you are saying. I was very active in my late teens and 20's I ran 5 miles a day then I had my accident and my back was messed up bad..at first I did manage it with medications,long story short..try not to worry too much. Be open to what your Dr suggests but also get 2nd opinions if possible...there is nothing wrong with taking medication if you need them,I have learned there are pro's and con's like with everything else in life..for me I would rather be a little groggy in the morning if I could control my pain and get out and smell the flowers vs. being laid up in bed in pain...anyhow good luck and try not to worry!!!I know that is easier said than done!
I dig the optimism. I am very much looking forward to many days of smelling flowers, being in pain will not stop me from any of that. Its good to know there are understanding and educated people out there. Kat, i do take up to six a day. Every four hours like clockwork, i never go over 6. Never go under 4. And they are 10/325 so I dont get as much apap but i take up to 4000 mg of nsaids a day. (Ibprofin, arthrotec) Plus herbal remadies. Marijuana helps for mental things, but not physical pain. California poppy is supposed to be good for pain. Bacopa for anxiety and sleep. But all this it keeps my pain and swelling at bay. And after 6 months of hydrocodone every day, if he doesnt give me anything then im in a world of hurt. He has all the documents of my medication lists so leaving a patient to deal with WDs would be cold. I am taking what you said into consideration though and Im preparing for anything. I wish he would even call to schedule an apt. Not knowing anything drives me nutts. I get bad anxiety and sitting around waiting sucks. I will keep posting as i continue on this road. Thank you all.
Marijuana helps for mental things, but not physical pain.
Hey, I'm going to say this, and then won't mention it again, because I'm not trying to harp on your or tell you what to do, but if you were to not get Pain Management because nobody mentioned this, I would honestly feel bad.
I've been in Pain Management for 26 years, in 4 different states, Texas, California, North Carolina and Virginia. I have never seen a Pain Clinic or Pain Dr. who sanctions the use of Marijuana or any other illegal substance for pain control, they just don't do it. Pain Dr.'s are controlled by Federal laws, not state laws....the FDA keeps very tight reigns on them due to the types of meds they RX.
When you go to your appointment, you will most likely have to take a urine test first thing....if they find any illegal substances or any narcotic meds in your system that you are not supposed to be on, they will most likely refuse to treat you...they don't mess around. Like I said, I'd hate to see you not get Pain Management treatment because of this.
My ortho informed me that the PM he referred me to gives referrals to marijuana prescribing doctors. I will only speak for what I know and pain docs here, as long as you have your medical marijuana license, don't give a hoot about marijuana. My uncle is a prime example. My buddy who sees 2 pain docs, he got his referral from his pain doc to get his pot card. I promise that is just how it goes here. I'm not a big smoker anyway and if it came to it I would stop all together. Luckily I don't have to make that choice, not now anyway.
As far as I know it would be very individual to the doctor...there is no protection for matters like drug screens for PM (or employment) with a medical marijuana card. Right now this is not something I would chance for myself. Even if your doctor told you they supported medical marijuana, someone else in the practice giving you a UA may not. Or, they could go against their word and only go by what is in your contract. It is still federally illegal. Maybe someday I'll feel comfortable pursing the treatment but right now there just isn't enough legal protection. Best wishes.
constant head pain, fibro, and other fun!
chronic pain established in 2006
I actually talked to my wife this morning, since this is such a sensitive subject now in both our lives, and i decided to not even chance it...Its not a big part of my life, and im in a small town where good docs are hard to come by so it would be unwise to take the risk. Its now been a week and a day since this PM got my info faxed to him and still no call to schedule an apt. I told my ortho I wouldn't be requesting pain meds anymore since his referral, didnt know it would take this long so im about out. I cant go and ask him for a nother script so its going to be a tough ride. I dont think I will feel too bad coming off 4-6 norco a day. The anxiety is what im not looking forward to though. And my hand is having more flairs than usual. Sometimes it gets so tight that when i move it suddenly, there will be a tearing feeling then about a minute goes by and the swelling and pain from it is tremendous. It doesnt do that when i wear the brace but the brace is tight around the bump and it hurts even worse. So my new name is Limited Mobility. I just thank god I can still walk. It must be a reverse feeling when two diff. people have chronic pain. One in their feet, the other in the hands. The one with the painful foot says "at least i can use my hands" the one with the painful hand says "at least i can use my feet." I took it for granted when i had both. My hat goes off to those who have bad spines and such that we only have 1 of.
LOL..and then there are those of us that all of our joints are affected, and I can tell you that really sucks!!
Good for you on the pot thing. If I was you I'd call the PM's office on Monday and see about getting that appointment scheduled....you don't have to wait for them to call you.
How long have you been on the Norco, how many months? If it's been several at 4 - 6 a day, you probably will have some withdrawal issues when you stop the meds. It doesn't take your body long to become used to narcotics.
If your appointment won't be for several more weeks, I doubt your ortho would have a problem writing you a refill, if you explained the reason for needing it from him...it's not like you can control when the PM doc schedules his patients.
Yeah Im in Northern California. "emerald triangle" is what some people call it. I called the new doc and his office said he usuallt takes a week to look over the referral and paperwork ect. So I have to wait for a call. Ive been on norco for almost 4 months. I was on regular vicodin for a month or so but quickly bumped up, I get a tolerance fast. They barely touch my pain now, but Im staying silent in the shadows till I talk to the PM and hear what he has to say. Im having to take that Arthrotec 50 junk, and it works for pain...only because it knocks me the **** out and makes me mental. Mostly Id rather deal with the pain and be coherant, but other times i just have to take it. And only on pill a day. Directions say to take 3 a day. Yeah right I would be brain dead. And i know im not supposed to try others medications, but my uncle was there when i busted my hand, he knows my situation. I tried one of his oxycodone immediate release...blue. And wow. I felt like I could karate chop a brick with my bad hand. I didnt know there is stuff out there like that. Is that how youre supposed to feel? i realize it goes down dose by dose but i gotta say if i have to go years with this pain to climb the ladder to that stuff, i would. Please dont judge, my uncle was just trying to give me a day of pain below a 5 and it was a 2 if not 1.
I hope you know me well enough by now...I don't judge, to each his own. The only reason I bring certain things up is to educate you. Because if you do stuff like that while your with a PM and on a Contract, they'll drop you so fast you won't know what hit you. I know you use your friend as an example....but I'd pretty much guarantee you he's doing a "run a round" on the system in order to get double doses of his meds. Pain docs don't work together to double RX the same meds....he's taking risky chances and they will catch up to him. A PM Dr. can call the pharmacy at any time and get a history of your narcotic meds.... When you start with the PM you have to agree to random Urine tests, they can do them at any appointment without notice or call you into the office to do one, without notice.
As for you high tolerance, I saw your post on the other board about some of your past activity...that may have an effect on why you become tolerant of narcotics so fast.
The "Is that how your supposed to feel?" question. NO, Pain Management is not about making you feel great/strong/stoned/euphoric/or pain free....it's exactly what it says a way to manage your pain. The goal is never to be pain free, because it's normally impossible to do within a safe limit of narcotics and other modalities of treatment. The goal of Pain Management is to get you to a level of pain that you can tolerate and still live your life with quality and allow you to work/be active/function/be a part of your family. Most pain patients never see below a 3 on the pain scale. My pain rarely gets below a 5, and that's with 150mgs of Morphine, 60 mgs of Oxycodone, 1600 mgs of Ibuprofen and Soma PRN each day.
I will be honest and say that one thing does concern me....you seem to want to be on Narcotics for the rest of your life and I've never met a pain patient that wants that. Most people are looking for a way to fix the problem and stop the pain....
I thought you were in Cali....I'm from San Diego, a Marine Corp brat born at Balboa Naval Base.
I love San Diego. Too big though, too much going on. And you're right about me wanting to be on meds. Not necessarily narcotics, I want to take something that works. I would take dog crap in a capsule if it helped with pain. And I want this because honestly, I don't want my wrist fused. I've read the patients bill of rights and California pain laws and for a person with chronic intractable pain, that's my right. I hope anyone reading this understands, I have taken every pill for pain out there (non narcotic), injections, blocks, you name it. Nothing has worked. And I am going to be in pain the rest of my life. I don't abuse, like I said I took only 1 of my uncles and it isn't going to be a habit. I just don't want to sound like a junky for wanting to take mediation that takes the pain away.
sorry i have been off the radar here for a while. had some sick issues to take care of with me and my big old pony dog who unfortunetly also has been suffering in pain from HIS new pain crap. fun. i just wanted to ditto esp kats last post about NOT telling your 'new' PM abut you trying someones elses oxy UNLESS you actually had a script for it yourself at some point. they kinda frown on that. plus, as of i think it was either the beginning of 2010 or 11? there was a federally mandated order/law put into place that stated that every single state in the US just HAD TO come up with their own form of of tracking system to keep track of any and all Rxes we get(most states use what is called the 'kasper system"). which i guess also includes pretty much any rx that is written for us since when i went to my last PM visit, when the nurse was going over my meds, she asked me if i was still on that zithromax, which actually came from my dentist, with absolutely NO narcotics asked for or given. i kinda freaked out on THAT med since we are talkin just a lowly lil anti biotic?? that just kinda threw me since i was under the assumption that the new monitoring law was ONLY for any actual schedule II and III type of, meds. guess not. there just was NO other way that they could have even possibly known about the zithro unless they saw it in that system. so anyone you just may know who is actually obtaining multiple Rxs for any narcotics could end up with some very big questions to answer to once this gets found out by at least one of those two rxing docs(and trust me, it WILL get found out one way or another here at some point). i do know pretty much ANY doc, dentist or any other person who had a DEA number to dispense narcotics at all, also has a particular "password' that also allows them access to your states monitoring system too. all they have to do is simply ask for it. so you may want to mention this to whoever gave you the oxy, or they could end up being found out, and also have any narcotic Rxing privledges either taken away(both Pt and the Rxing doc) or on a more permanent basis(both Rxing docs), depending more on just how may seperate offenses are out there, at the very least, a suspension on ability to even write any narcotics at all for a certain period of time. and unfortuently, this would also impact MANY different legitimate CP patients who would now also have to try and find another pain doc which aint easy, esp when there are a ton of other 'new' CP patients who had been seeing the doc(s) that got shut doen and raided/audited by the DEA and is not going to even be allowed to 'appropriately' treat their own patients anymore too.
this system was implemented mostly to try and stop the insane amount of doc shopping that had been going on out there and is also what WE, the legitimate CP patients just are paying for now with much more DEA involvement just hanging out in OUR overall paincare too. i personally have no probelms with this, except i never knew that they also monitored EVERY single flippin med that we now take, even stupid anti Bs? that just honestly really shocked me when that nurse even MENTIONED that anti B of all things, good god. you just have to be VERY carefull in 2hat you just do or do not do in the world of PM and follow any contract TO THE LETTER as well. that way, the chances of anything happening that could get you dismissed is really quite minimal.
most PM clinics will try like heck to get you on at least some form of long acting type med and usually at least some break thru type of pain meds as well. i started on, or my very minimal dose that i had been getting from my primary was raised up over time once i finally got to a pain clinic setting along with two 'allowed' BT pain roxicodones 5 mg as well. this combo worked really well for me and still does with the OC anyways. we did have to switch to MS after the 'ethex drug co's recall a few years back where almost no one could even GET their roxi since the DEA had limited only two manus(ethex and another comp called roxane) of these types of meds? pretty sick time for many of us. MS was my only other option as far as BT meds.but i stayed on my same doese of the OC and have been on that total daily intake of OC since 2005. we have just switched my meds around a few times where i 'thought' i needed a raise, but just switching them around actually did work and i ended up not actually needing a raise in my meds at all. sometimes it simply takes some adjusting in your overall dailyintake but worked out in a different was just to 'fix things' without the need of actual raising of anything. i also try and use alot of other modalities that mostly because my narcotics do not even begin to touch esp two ecxcruciating pain syndromes i ened up with following my cord damage, NOTHING will touch at all, esp narcitics,
so these areas, and i have found they also help areas that my narcotics also helkp have been my go to's when things are hitting the fan. something like the TENS unit co9uld even possibly help with your type of pain as well along with things like using the lidocaine patches and or the lido ointment. heat and cold have done wonders too for certain types of pain when tyhey get kinds ugly as well. you just try as many diffeent modalities as possible, both med, ointments/topicals and any real good types of recommendations like possibly even ablatimng the offending nerves would help.
but the main thing ypu just DO have to have here is stability in that wrist and hand. so if that cannot be achieved by anything i mnetioned above, there may just be that surgery as your only real true option. PT only takes us so far, trust me on that one. if that ball hurts to much to use, ask yopur PT or ortho to track down the many differemnt clays that also do the job of that szqeeze ball. they have different color clays geared specifically to 'your' ability levels that trust me, do NOT hurt as bad as that more solid ball does. once you have mastered the one color clay, they simply move you up to the next strangth level. this, and typing seriously has been what allowed me to regain a TON of mobility in my very pathetic L hand that knocked out sooo many finger ROMS(the push and pull functions depending upon what finger was involeved) and a really awful/pathetic thumb in that hand too that was a result of the biggest 'hit' that was at where my vascular lesion was just located at that c 8 nerve level inside my cord. so while they were in there,and i was warned pre op that the fine motor funtions to my hands along with the nerves that went to my feet were smack dab in the way, but HAD TO take that option or could have become paralyzed by just even one more small bleed in that glob again. what lovely options. but they hit all of my hand/finger nerves while they were still bundled inside that cord all in one fell swoop, and ened up not only losing all the ROMS i mentioned above, but they lost the sensory at the ulnar which was hard enough to also knock out its motor counterpart, which believe it or not IS in that raduil side? my thumb sucks,alot now. but you CAN ragain function again using the 'appropriate methods in whatever you decide to do. it just takes ALOT of repetition and using BOTH hands together to relearn how to do any tasks that just require the use of both hands to accomplish too. i really am amazed at what i actually DID regain again, not only with my hand but i had my L leg also completely knocked out when they hit my motor nerve and lost it for about a munute on the monitor,and then FINALLY came back, but now it fires in a very bizzare way and i could NOT for the life of me even hold all of my huge 98 lbs either upon my initial stand after four days of lying flat(leg just crumbled right under me). now THAT scared the crap outta me, but i CAN WALK again. something i was not too certain was ever going to happen. i was VERY dang lucky to have the most amazing rehab hosp that we just happen to live within about ten min of by freeway. i just did not know, considering, what i even 'could' get back. but walked out those doors i was wheeled into, all on my own(with hubby standing in front of me with my walker, but THAT was a goal i had made to myself as i was being wheeled in that first day from the surgical hosp)
you DO have a big decision to make LC. but the ONE huge thing that you NEED to do before siging any consent papers is really fully reaserch the type of surgery you would be having along with what outcomes(pros cons too) others have had as well. and then also find out what PM along with a different type of superior hand therepy PT can simply do for you as well. that may take a few visits tho to fully get a 'feel' for the type of PM you just end up with. but your MAIN goal here overall LC is what are you willing to live with and accept as far as pain, suffering,and more critical, what instabilities and losses of ROMS you have now, and what is going to potentially deteriorate over time if that surgery is not done. and what specific benefits just going ahead with that surgery would provide, but more importanly here, just what IS or would not even BE 'rehabbable' considering your own individual situation. there just ARE the many things you realistically just HAVE TO KNOW before 'deciding anything that you cannot take back. i really do wish you soo much luck with this decision LC. please DO keep us posted, marcia
11-20-01,placement of hardware for failed fusion
9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.
I Appreciate the reply. My uncle is actually the one whom gave me that pain pill. It was a one time thing and I would never bring it up to any of my doctors. And this guy I know who "doc shops" is a friend of a friend. He actually sees two pain docs who practice in the same portable. How's that for balls? I finally got a call back from my pm and the earliest I can get in is the 6th of July. So my ortho has me on lyrica, norco and my needed cortisone injections. My hand is getting worse. I'm now getting horrible spasms and they hurt. I just hope this doc can do something for me. I'm approaching any form, start from non narcotic and work my way up as needed. I admire how you have overcome so many obstacles and I know life is bitter/sweet. But I just found out my first kid is on it's way so I cannot fuse my wrist. Not yet. I have no slowing down in my future. Thank you so much for your advice and kind words. -Joey
Thanks so much. We've been trying for almost a year and I was convinced something was wrong on my end. But who woulda thunk it? That makes the whole fusion of the wrist subject even more sensitive. At least I have an apt date with pm now. Worst part is not knowing what's going on.
sorry LC i have been off the radar here. i just first wanted to also say congrats on the little one. but what i am wondering, seriously, without getting that wrist fused, could you even realistically hold the baby, and to the point where you and your wife felt she or he was actually just 'safe"? that is just one thing here that you REALLY need to also consider. and that baby will keep gainig wieght, and at times much more quickly than you may think they would too. this just really is, one of the bigger areas where you absolutely 'have to" be certain that because of your wrist, something does not accidently happen to that baby. it just 'is'.
this IS kind of a big deal here with the trade offs either way, ya know what i mean? also, continuing to take that much tylenol (was it 40 per week?) IS impacting(and already has) your liver and your kidneys too.
i have no real clue just what this new PM is going to Rx you that will simply take care of your pain but NOT the instability. only a surgical fix can really do that to the point where things do not accidently slip out of your grip because it just 'cannot" be held onto anymore. i went thru this when i had alot of my fine motor muscles and some sensory from a surgey done on my spinal cord in 03(my left hand was just totally lame). and there are STILL things i simply cannot do and others that required a ton of rehab(both in hosp amnd out pt) and then after i got home, just to open a dang window, it took me well over a month of 'practicing, using both hands together to just 'do" that one simple thing and other simple tasks too that we all pretty much take for grnated til we just 'can't" for some particular reason.
when you mentioned that just using that a squeeze ball caused you pain? that usually is a rather big indicator of one of two things or both. either the PT that is absolutely needed after any surgery involving the hand was not long enough, or in depth enough, OR something IN that hand NEEDS to be fixed. trust me when i say, no matter how badly you feel your pain is now, it can ALWAYS become much worse depending. that has been not just my own experience in many areas in myself that are a flippin mess, but a ton of people who post here on this site have suffered that same fate. and then there is always loss of ROMS too that we also take for granted. if you did not have a brand new baby coming(how far along is your wife?) that would beone thing, but you do NOT want to ever place your child in any avoidable danager when if having a surgery, while it will somewhat linit youir monbility, at least you will have strangth backing you up when you hold him or her,ya know what i mean? PT can help toms after that surgery to first get some mobility bavck and that needed dexterity too.
trust me LC, you do NOT want to 'have to" spend your life living on narcotics if you do not have to. once you start actual PM, many things will change there, along with you having to sign a contract stating that you will never ever "over use" your meds for ANY reason(telling them i had a "bad' pain day wont cut it either since you should always call when that happens FIRST, and never are you allowed to what they see as 'self medicating'), and the mandatory UAs that they pop on you at a moments notice. then pill counts as well. there is just ALOT more responsibility involved on YOUR end with getting meds and other modalities that they see as potentially being helpful to you and your particular pain.
if you actually had the surgery and still had some residual pain to deal with, that at least would be seen more as someone doing everything they possibly could to just rid themselves from pain as opposed to 'only' using meds/esp narcotics for your pain when nothing was ever 'done" after a screwed up surgery to even try and fix the problem? you just also 'could' lose even more use of that hand as a whole down to your finger dexterity by not doing anything to just actually fix the real underlying base of your main problem in that hand too.
if you have ANY loss of ROMS anywhere in the hand/wrist or fingers at this point, THAT will become worse since you simply cannot yet move it enough to rehab those areas back. i still cannot rotate my thumb on that left and alo lost alot of different fingers 'push pull' ROMS as well(this is why my typing just looks sooo crappy). if i do not keep typing, which was what actually was the very first thing i did/tried while in the rehab facility i was in to just start slowy getting some spread in my fingers along with at least 'some' strength as well, i actually really quickly start to lose what has now taken me in some cases, years to get back or 'maintain' if i for some reason just have to stop typing. it justs to go very fast. it HAS to be a constant and ongoing thing when you have losses of esp muscle and of course the tendons and ligaments attatched to them.
i just really DO want you to be making good descisions based upon what your ortho has told you, what you feel everyday and just basic common sense. you HAVE to do what IS the best possible option for you AND your family now, and in the longer run LC. PM is just going to be a different type of pain management than you are used to in automatically getting 40 hydros per week that you were. i just hope you make the 'right' decision here for the rignt reasons. marcia
11-20-01,placement of hardware for failed fusion
9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.
Hey Marcia, you really brought up some good points. She is about six weeks into it so early February is the date. I am grateful I have that time to figure out all I can about this situation and make the right decision.
I still have strength in my arm and wrist. I'm convinced my ulnar nerve is severely messed up. Among other things but that is the main problem. The pain travels down my whole forearm to my elbow and it can sometimes throb for an hour or two. As far as use goes, my thumb index and middle finger are ok but the last two are useless. Numb, tingly and extremely sensitive.
I have too much time to think about pros, cons, affects, effects of every option given to me. The fact my ortho didn't jump on fusing my wrist without meeting with a pm makes me think even he doesn't think it's the best idea. I had PT after surgery for 60 days and no improvements. He knows what I can do with it, the only problem is the pain. Which can me managed. And I can live with that. Sure narcotics long term are barbaric to some, and everyone says so. But I'm going to become dependent on these lyrica with bad withdrawals if I stop. Nobody seems to worry or cause a fuss about that.
I just don't think my life and family will suffer with me being on pain management as much as we would suffer without it.
At least maybe if (when) it gets worse years down the road I can taper off and do the surgery. Heck maybe the pm won't put me on anything, he may be a injection and hot/cold on the affected area doc. I'll do whatever he says. But I've basically been on baby pain management since December. I mean taking narcotics, non narcotics, and I've been fine given the circumstances. I've stopped the norco for 2 weeks. Wasn't pleasant dt wise but I found out they really help with pain.
The baby is all I think about and it needs a dad who cannot only pick it up and play, but have a loving positive attitude. I'm a Scorpio so I'm an emotional person anyway and when I'm in constant pain, I am a recluse because I dont want to be an *** to my loved ones. So I'm trying to avoid problems I'm sure you people have to deal with. Yeah physical pain is the pits, but emotional pain can be worse so if these barbaric pain meds and injections help, by all means sign me up.
In conclusion, like i said in previous post, I cannot see bolting a plate to my wrist skeleton bringing much relief. Not trying to sound negative im just a realist.
I think one thing that Marcia has concerns with and I have concerns with that neither of us have come right out and said because we don't want to seem like we're pushing you to make one decision or the other, is the meds your on currently.
Hydrocodone is the easiest narcotic to abuse and become addicted to and one of the hardest to detox off of. Long term use of it leads to nothing good. It can grab ahold of your life and before you know it, it's taken over and you don't know what your doing anymore. Everyone enters Pain Management saying, "I'm going to play by the Rules and do exactly as I'm told" We all have the same good intent. But that drug has taken down many a Chronic Pain patient with good intentions. It's not meant as a longterm chronic pain med and you're already taking large amounts of it.
I'm glad they've got you on the Lyrica, I know your scared of it. But I think your more scared of the hype it's gotten. Yes, it is a different class of med and you do need to learn about it, but it is better for the type of pain you have. It does have it's side effects and dependence factors. But so far you seem to be tolerating it pretty well and it's helping. The fact is, your not going to get very good coverage from any narcotic for the kind of pain you have. You can search this Board and find many, many people with the same kinds of neuropathic/nerve pains and they battled for years to find a combination of meds that worked. You've only been doing this for a few months.....you've learned a lot from the folks on these Boards and there is so much more to learn...but you have to do that. You can't just think okay, narcotics forever, that's the plan, I'm good, let's go. You have to research and find what's best for you and your pain.
I know, God if anyone does, I know that the thought of surgery in a life altering way is scary...it is, and it does force you to re-evaluate and learn knew ways to do things. And it's not the right thing for everyone. But, being gung-ho to jump into a lifetime of Pain Management after a few months....I guess we're just trying to make sure that you've thought about what that entails. It's not just about the meds., there's also the changing Dr.'s, sometimes frequently, through your fault or theirs, without warning; and a new Dr. is not always easy to find. You'll be going to the Dr. every month or quarter and your scripts will be filled every month, your 25...have you factored the cost? If you keep decent insurance, just in Dr. visits and medications if you do Pain Management for 25 years your looking at $60,000, that doesn't include testing, images, procedures, or insurance costs. The meds...you will be changing meds, the meds don't work indefinitely, if your lucky they last for a few years, then you change them up and since your so young your going to run into 2 big problems, 1. tolerance, 2. Availability of Meds, there are only so many choices. Insurance plan changes, paying for Dr.'s & meds. Pharmacy issues; these can be constant.
So, just, when you say you've considered your options and you've chosen Pain Management, make sure you've considered all of what Pain Management entails, because it is not an easy life to live by any means.