[Hi everyone I hope you are having a pain free day.
I had a few concerns over my recent pain clinic visit. As a little background I have been having sever back pain and pain in the bottom of my spine for quite some time now. Well I finally get into a pain clinic after a 6 month wait for the appointment.
I get there get called in back and the doctor I was sent to see by my GP and who was recommended to me because of his specialty in difficult cases such as mine never comes in the room. Instead two other doctors come in the room one a resident one a anestegologist (sp). The resident starts asking me questions and i start answering him letting him know whats been hurting and how my doctor has been treating me. My doctor has me on two norco ever four hours for pain. So I tell the resident this still at this point thinking the doctor i was referred to is going to come in after. As soon as he finds out im on pain meds he tells me to get up so he can look at my back. He asked me where the pain was I tell him bottom and right shoulder blade where I have a scar from when i had surgery as a baby. Well then he starts asking the question over and over again as he bends me forward backward and presses very hard on the bottom of my back to the point i doubled over and broke out in tears.
So im sitting there shaking and crying cause im in so much pain and he walks out of the room i assumed to get the doctor i was there to see. He comes back with the anestegologist(sp) who starts questioning me like some drug addict that came off the street for a fix. By this point I am not only in pain but upset by the third degree interrogation i am receiving. he's in the room for ten minutes gives me a referral for a mri and a muscle relaxer then tells me he wants me to get shots next time i am there even though i expressed concern over them considering he wants to mix two different medicines together in the shots which i never heard being done before. Without explaining the risks or benefits to me or anything about the procedure he simply walks out the room with the resident dismissing me. As im heading out he stops me tells me to fax the mri results to him after i have it done and says " if you dont do the mri dont call me dont even bother calling me" and walks off again.
fast foward to a couple days ago and my doctor said that they would be taking care of my pain meds so i call the pain clinic to ask them about my meds and how it was going to be handled. The nurse asks me what im taking and i tell her and very rudely says " That is way to much medicine he will never do that for you!!"
She goes and talks to him and comes back and says he said just have your doctor deal with it till he sees you again. I said ok thats fine but my doctor said that you guys would be taking care of it since i am under your care. she then says" what did i just tell you call your doctor and tell him what i said!" and hangs up on me !
Needless to say i am not happy with them or feel i am getting adequete care. I called my gp and he said the one doctor that saw me is not even a pain doctor and the other is just a resident. The doctor i was suppose to see never came in the room or talked to me or ever even called me. Me and my GP are very confused why these two doctors came in to see me and decided not to do anything for pain. Anyone else have a experience like this ? Am i wrong for being hesistant about going back to them for care? Sorry this is so long .
Thank you for reading and all advice is welcome
Have a pain free day [/B]
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Well there's some confusion with your Dr. here. A Pain Management Clinic is made up of a variety of Dr.'s. An Anethesiologist can be a pain management Dr. as can a Neurologist, those are normally the 2 type of specialists that make up the bulk of PM Dr.'s. It's not unusual to go to a PM Clinic and see one of any of the Dr.'s or Resident's or PA's that are on Staff. When your GP's office made the referral there may have been a mistake in the paperwork and it wasn't clear that you were supposed to see a certain Dr.
The "3rd" degree. On a first visit to a PM Clinic when your already on a significant amount of pain meds that's going to happen, not much you can do to get around it, and 12 Norco's a day is considered a significant amount, especially if you've not had any tests or labs done. Them not automatically taking over your GP's prescriptions for the Norco is also pretty routine, they don't just take over another Dr.'s scripts for meds. They examine you and decide what meds you need to be on.
They are treating your pain, they RX'd you a muscle relaxer and want you to do injections, and btw the 2 meds in the injections aren't unusual for PM, it's most likely a numbing agent and a steroid. Most PM Dr.'s want you to try every modality of treatment you can before large amounts of Narcotics, and resort to the narcotics only as a last resort. Injections for back pain are pretty standard.
As for the abruptness and rudeness, unfortunately you can run into that alot in PM Clinics....patients tend to have to prove themselves these days with alot of them. It's not right, it's not warranted...but all you can do is go to a different PM Dr. The Clinics are worse than just a PM Dr. in his own practice. The Clinics stay busy, are usually overbooked and can easily get that "revolving door" feeling about them.
You really only have 2 choices at this point. 1. Do what they've prescribed: Take the muscle relaxers, get the MRI, and do the injections. or 2. Find a new PM Dr.
If you stay with them when you call for your next appt. you can try and request the Dr. you want to see specifically, not sure if that will work, but it's worth a try. You might also have your GP call them and reiterate that he wants you to see that specific Dr.
I know none of this is very reassuring...but this is how it is in some of the bigger PM clinics.
Not too much hyrocodone...too much Acetaminophen. Okay for a few days, but really dangerous for your liver if taken regularly. Current guideline for daily use is under 2000mg per day. For occasional use, 4000mg max. My PM and PCP docs both think even that is too much when you are talking about daily use for years. Be aware that there is also Acetaminophen in a lot of OTC products you might also use.
That is a fact. The problem is at this time the next up short acting med you can get in "pure" form is Oxycodone, which is the active in Percocet. Unfortunately GP's, MD's, PCP's and even PM's are not going to put Pain newbies straight on Oxycodone for pain. They go through the Tiers of the lesser meds first, Codiene, Vicodin, Lortab, Norco, etc. and all of those have APAP.
The standard post-op pain med is still Percocet, with an average dose of 4-6 a day, which puts patients in the danger range for APAP.
Most pain patients don't see an actual Pain Management Dr. until they've been dealing with their pain problems for a year or more. And GP's and PCP's don't RX the bigboy LA meds, well with the new laws that are going in to place they can't.
You have to remember, her Dr. prescribed her that amount of Norco and he knows the limit and danger levels of APAP. As long as Dr.'s don't care to worry about the Danger of APAP, it's going to be hard to get the patients concerned about it.
The only thing here I have to add is I too dealt with the pushing of muscle relaxers on me vs the norco. In my case, I told them I work, have three babies and muscle relaxers are just too difficult for me to function on as my main medication. So I compromised and said I would be willing to try a relaxer that didn't make me sleepy in combination with my norco and honestly they work quite well together. If it helps I found that Tizanidine doesn't make me as sleepy and does help with some of my pain so I take those at night and have been able to add one in the middle of the day if I need to since it doesn't make me as tired anymore. I think for me, just the willingness to try other options (I tried tramadol as well but had a bad reaction to it and the naporoxen raised my blood pressure and makes me feel lightheaded) softened them on them thinking I was just seeking opiates. So now my chart for any Dr shows that I am not merely saying I don't want them or they don't work, they can see for themselves the reasons I am not on those. I mean we have to try and work with them even if we think we know what our best treatment is. And I am grateful for it because I have been able to maintain the same dose of norco (10mg 3x a day) for a year and I know building a tolerance is always a concern.
I'm sorry I should of been clearer on the medicine I am taking. I only take 6-8 a day no matter how long I am up. (sometimes due to the pain I only get 4 hours of sleep) . I can see how it looked like I am taking 12 a day no only 6-8.
I did ask the pain management doctor if there was a non-narcotic medicine that he could put me on that would do the same for me as the norco and he kinda blew me off . He never even answered me. I'm willing to do the shots just was very concerned that he didnt explain anything about them nor does he have any idea whats even going on in my back to do shots. It sounded like to me the way he explained it was whatever the MRI shows were doing these shots.
I have tried all other medicines me and my GP could think of but it makes it hard since I am allergic to two of the main ones they use on people which is Ultram and Relaphen. So I wont take anything in the same class as them for fear of allergic reaction and stomach problems.
I would like the problem to be solved so I can stop the medicine all together but I do realize what kind of bind i'm in right now being as we haven't gotten a diagnosis yet.
I also understand they do have to weed out the drug seekers from actual pain patients i'm sure they do get a lot of drug seekers .
Thank you for your helpful advice and tips. I was told to stop taking the muscle relaxer by my GP he said the stuff I am taking is no good for me . So I am waiting to do the MRI and then call the pain clinic back.
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Then all of that should be in your records and it does sound like to me that you are not being cared for properly. Oh and I totally understand feeling uncomfortable being rushed into something where the side effects or risks aren't discussed thoroughly with you. That happened to me and although the procedure was most likely the right one, I wished I would have changed Drs at that point because possibly a new Dr would have not had the incident happen in mine and I would have felt better about it being my decision going into it. I think it's unfortunate for us at times, when we have to walk such a thin line between taking matters into our hands with our care and having fear over how we will be treated if we ask for a second opinion. So sorry you are in this position.
I'm just tossing this in for information purposes. Ultram and Relafen aren't really standard or typical meds used in pain management.
Ultram (Tramadol) is still considered relatively new and is a pretty dangerous drug. It's being used less an less because Dr.'s are learning that is is Highly addictive, very hard to detox off of, easy to overdose on, causes Grand Mal seizures and when mixed with psych meds can cause Serotonin Storm or Syndrome. All this from what was supposed to be the new "wonder" non-narcotic pain reliever. It's more dangerous than most narcotic pain relievers. It also has an anti-depressant quality built in that causes additional problems.
Relafen (Nabumetone) is an NSAID used to treat Osteoarthritis mainly, you're 1 of 2 people I've ever heard mention it on this Board.
So, these 2 aren't really big mainstream drugs in the Pain Management game. There are many other short acting and long acting meds that you could take that would better control your pain. Even at 6 - 8 Norco a day, your taking 3000 - 4000 mgs of APAP (tylenol) a day, the max. daily dosage is 2000mgs. Taking that much APAP each day over an extended period of time will destroy your liver and kidneys.
The reason the Dr. shrugged off your question about a non-narcotic med replacing the Norco, is 1. he sounds like a complete God-complex Jerk, and 2. there really isn't one.
One thing for you to remember and consider. When you go back to the PM, if they have you sign a Contract, you can no longer go to your GP for medications or medication advice. When you're on a Contract with a PM you can only get your Pain Meds from that Dr. If you get pain meds from any other Dr. including the ER, unless it's an Emergent life-saving situation, they can and usually do dismiss you from their practice.
You really seem to be having a "time" of things but maybe everything will work out with the PM. I wish you all the Best!
As far as non-narcotic pain meds, I was put on Lyrica recently and although it does little for me, it may work for you. I didn't think I'd seen it mentioned, so I thought I would toss that out there for you. Take Care!
I have a physiatrist/PM doctor who specializes in spinal cord injuries for my PM doctor. This works out really well for me, since I got a spinal cord injury after my first back surgery, so along with anesthesiologists and neurologists, PM doctors can also be physiatrists as well as having other sub specialities under their MD as well.
It is common practice to suggest injections of various kinds for any number of back problems, so the doctor telling you that he wants to do injections is not unusual and when I had mine, no one explained what type of injections or what was going to be in them, until the day of the appointment for them. Then before giving me the consent forms, someone came in and explained what they wanted to do, what medications would be used in the injections, so again, it is not all that uncommon not to have that explained at the first appointment.
Physical therapy is probably also going to be another treatment option given to the original poster, after the injections and the MRI are done. The MRI will hopefully provide them with some information regarding the type of injury and location to be try injections and give some indication about the need for further interventions or surgery possibilities down the road.
If I were you, I would get the MRI done, go back for a return visit and see what the findings were, and then talk to the doctors and see what treatment plan they come up with for you........most PM doctors don't give much information to a new patient on the first visit because there isn't much information to give when there are no studies ( MRI's, CT scans, EMG results, etc to go over first before the exam) so they prefer to wait until they have a better grasp on the patients complaints and some imaging to work with first before telling a patient what they believe may be coming down the road. As for them not giving you a new prescription for meds ( Norco/vicoden), there are not many doctors, PM or otherwise who just will continue to give out medications that a patients tells them were being given to them by another doctor. They prefer to see for themselves what the medical problem may be, and then follow their own treatment protocols, deciding which medications may be best suited for the conditions.
Ok, guess I am going to be the only naysayer! I think you were treated very poorly and unless I got a guarantee from your GP that he spoke with the specialist himself and that he will see you when you go back on your next appointment, I would not go back. Yes they need to ask the questions, but there is a way to do it that is caring not offending. They do not know you and have no right to treat you like an addict unless you give them reason to think so which you definitely did NOT!
I don't care what kind of doctors they were I would never go back if I was treated like that. I have been in PM a long time and have had 3 doctors due to moving. I have been with my current doc now since 2003. Each one of the practices, doctors, PA's and nurses have been the most caring and considerate people I have met. I have always been treated with respect and kindness.
Since both the Anesthesiologist, the resident, and the nurse spoke to you like that I would say that that is how they all probably treat most everyone and I would not be OK with that. I would ask your GP to continue to prescribe your meds until you can find a PM who treats you with respect.
I am not necessarily disagreeing with their treatment plan, it's the way they presented it and never talked with you about it. I see my doc for cancer and autoimmune pain, but I do have some low back tailbone issues. I had never had injections and we sort of tossed it around a few times and then when I decided to have them, everything was explained completely to my satisfaction.
Again I would not be OK with a practice like that and it is not typical to be treated like that from all the staff.