After more than 10 years of semi-successful PM with 2 different Anesthesiologist PM doctors I am going to jump ship and try a different type doctor.
I have been getting 4 level cervical facet injections 2-4 times a year. They USED to give me additional pain reduction along with Lortab and either Neurontin or Baclofen for a few weeks/months. Never enough to reduce meds though. They no longer are providing any relief and my current (now former) PM just wants to keep trying various injections (Botox, epidurals etc...). This clinic only wants to do "procedures". They won't see you for a mere office visit or follow up appointment - just for procedures. Seems a litte $$ driven to me.
He closed his private practice and joined a large PM Clinic a year ago. Too bad - he was a caring and compassionate PM doc who always took time to talk with me about my conditions, treatmentment options, my general health... Such a switch in personality once he moved to the large hospital based clinic.
I have 2 reasons for getting away from injections (besides the fact they no longer help). One, I do not have health insurance and the last set of injections cost me $4,300. Ouch! Can't afford that. Two, I'm starting to have concerns about repeatedly injecting steroids into the same area for so many years. While they do reduce inflammation, don't they also "damage" healthy tissues??
Through discussions with my PCP, she suggested I could try a Physiatrist (Physical Medicine / Rehab doc) for a different approach to managing my pain. I have done lots of PT over the years and Chiro. I still do stretching and isosemetric exercises at home most days, but no longer see a chiro since discovery of spondylolisthesis C3/4. Most muscle work (massage etc) just seems to keep my neck, upper back and arms in an "irritated state".
Although excited for a fresh set of eyes, I have no idea what to expect from this field of medicine for chronic pain. I know we all have different issues, but if I could go in knowing something about their approach, it would be helpful.
Would anyone seeing a Physiatrist share what type of treatment regime you are receiving? I'd greatly appreciate any input.
The one at the main local surgical center/practice is its PM dept. But he only does injections/procedures, non narcotic meds, and referrals to the surgery center's own PT clinic. He is not involved in the PT.
An hour away is a pain clinic headed by a Physiatrist. It does injections, all meds & med management, in house PT, and has a Psychologist. Staying on there is reported to mean at least one injection series per year.
The other local physiatrist runs a Sports Medicine clinic. From what I hear he does primarily evaluations and non narcotic meds, then referrals to various PT clinics, injections at the hospital, and to surgeons.
__________________
C3-C7
Severe DDD, Severe neural foraminal stenosis at 2 levels, moderate canal stenosis at 2 levels, significantly impaired left shoulder & arm function. Chronic moderate compression fracture at C6.
Thanks for your reply and taking the time to share info on what appears to be several docs of this type in your area.
I had heard physiatrists don't do injections. (Though seems now that some do). I guess I'm hoping for a doc who will take more time to evaluate my problems and form a plan instead of just "experimenting" with various expensive injections. Obviously I don't completely agree with my former PM's assessment or treatment plan.
I'm open to trying different treatment options - just tired of being stabbed in the neck. I've even considered tapering off all the meds and reevaluating where I'm at.
I appreciate your input Daffydolphin.
Anyone have thoughts on the long term repeated use of steroid injections?
In defense of Physiatrists in general, I have talk to people in a major metro area 3.5 hours from me who love ones they go to. Consider their's excellent for giving unbiased coordination of all options available for Pain Management. Some are personally hands-on, others refer to PT clinics, but with detailed iinstructions and cautions.
We just don't have those physiatrists in this more rural area.
When I was going to the physiatrist at the surgery center PM dept previously mentioned, he said up to 6 injections in 12 months is okay while admitting guideline is 4. My research indicates that is pure $ making bull. My current PM Dr. says 2 per year and then only if they give significant relief that lasts more than a month or two. I had 8 or 9 injections over an 18 month period. The first two help for about 6 to 8 weeks, the rest gave no relief. But the doc kept wanting to schedule more.
My PCP and PM Dr. don't want me to try any more steriod injections. The surgeon that is currently monitoring my spinal situation also leans towards the negative on further injections. I do not plan to have any more unless my PM retires and some new PM requires me to try again as a condition of continuing opioid medication management. I personally consider the longterm use of steriods as more hazzardous than the longterm use of opioids.
__________________
C3-C7
Severe DDD, Severe neural foraminal stenosis at 2 levels, moderate canal stenosis at 2 levels, significantly impaired left shoulder & arm function. Chronic moderate compression fracture at C6.
Last edited by Daffydolphin; 02-18-2013 at 09:33 AM.
Reason: Add an opinion.
The Following User Says Thank You to Daffydolphin For This Useful Post: hillcountry63 (02-18-2013)
Hi,I have been seeing the same pain mgt specialist who has a psyiatry background for about 6-7 years now for a few different things but mostly my lumbar and cervical area.
In 06 and 07 i he performed two non evasive techniques on me, disc biacuplasties which involved heating two probe/cannulas like things that were water cooled into my disc, heated the disc up, then I wore a hard brace for 4 weeks, then a soft one for 2 then they were repaired.
He has also given me epidural injections, facet injections, radio frequency nerve ablutions and some steroid injections in my ribs more recently.
He also treats me with nerve pain and narcotic medications.
I have in the last two years been restricted to my steroid injections due to another dr. Putting me on long term steroid med unnecessarily causing me to develop Secondary Addison's disease.
I now have to ask for permission from my endocrinologists (who treats me for the addisons) to receive a steroid injection.
So please do listen to the rules of no more than (I believe it's 3) steroid injections per year. Keep in mind any other steroid you may receive for other illnesses such as poison ivy, chest congestion, etc. they all add up.
Good luck finding another dr, I know I would be devastated without mine!
Ps I wanted to add after rereading your post you said you were getting facet injections, right? Did they ever mention radio frequency nerve ablation? This is where the go in and test and find the actual nerve causing your pain (not your motor nerve) and burn it off. Now this sounds painful but it is water cooled too I believe the worst part to me is them trying to find the nerve they attach a wire at the end of the probe touching the nerve and its kind of "nerve wracking" no pun intended lol! Usually this is the next step after facet inj
Cathy
Last edited by noevr; 02-18-2013 at 11:28 AM.
Reason: Add more stff
The following user gives a hug of support to noevr: hillcountry63 (02-18-2013)
The Following User Says Thank You to noevr For This Useful Post: hillcountry63 (02-18-2013)
My pain management doctor is a physiatrist, and I couldn't be happier! I happened to stumble across him (ran into someone randomly at the pharmacy who recommended hi to me), and at the time, I was very unhappy with the pain management doctor I had been going to. Same story as yours -- he was injection-happy, didn't spend any time with me at all, and didn't care about what my opinion of my treatment should be.
I decided to give the physiatrist a try (had never heard of them before), and this guy spends at least an hour with me at every visit, discusses my pain, my medications, what therapies I've tried, etc... and he does a full evaluation with each visit to make sure he doesn't miss anything. Yes, I had to have a few series of x-rays done on top of all of the previous testing I had had done in the past, but he helps manage my pain. He has physical therapy in his office, if I want to try that, he's done spinal manipulation to relieve pressure on my back, has offered acupuncture and he will do cortisone and trigger point injections, but does not do nerve blocks or epidurals in his office.
I'm just so thrilled to have someone who isn't injection-happy in my life, and actually listens to me and takes me seriously when I discuss my pain.
I only wish everyone had a pain management doctor that cared as much.
Good luck in your search for a PM doctor you can trust and put your faith in!
The Following User Says Thank You to Megonlegs For This Useful Post: hillcountry63 (02-18-2013)
..... I have in the last two years been restricted to my steroid injections due to another dr. Putting me on long term steroid med unnecessarily causing me to develop Secondary Addison's disease.
I now have to ask for permission from my endocrinologists (who treats me for the addisons) to receive a steroid injection.
So please do listen to the rules of no more than (I believe it's 3) steroid injections per year. Keep in mind any other steroid you may receive for other illnesses such as poison ivy, chest congestion, etc. they all add up.
Thanks for the heads up Cathy. I began treatment with inhaled steroids for asthma within the last year. I had forgotten about the cumulative affect.
Quote:
Originally Posted by no34evr
Ps I wanted to add after rereading your post you said you were getting facet injections, right? Did they ever mention radio frequency nerve ablation? Usually this is the next step after facet inj. Cathy
I would consider RFA if I felt confident that is my pain generator. (How do you know?) My former PM wanted to schedule it, but ordered an extension-flexion set of x-rays first. After seeing the films, he changed his mind and then offered epidurals and Botox. Since he had become so non-communicative, it wasn't explained why he changed his opinion. He only said all of my issues were getting worse and would continue to do so. This is when I decided I needed to move on. I saw another PM for a consult. He proposed experimenting with nerve blocks, more facet injections and possibly RFA.
I'm beginning to believe some docs are too focused on the money in procedures and not the patient. JMHO
Sorry to know of your conditions, but glad you are blessed with a good doctor. Thanks for sharing your experience. I appreciate the feed back.
When I was going to the physiatrist at the surgery center PM dept previously mentioned, he said up to 6 injections in 12 months is okay while admitting guideline is 4. My research indicates that is pure $ making bull. My current PM Dr. says 2 per year and then only if they give significant relief that lasts more than a month or two. I had 8 or 9 injections over an 18 month period. The first two help for about 6 to 8 weeks, the rest gave no relief. But the doc kept wanting to schedule more.
My PCP and PM Dr. don't want me to try any more steriod injections. The surgeon that is currently monitoring my spinal situation also leans towards the negative on further injections. I do not plan to have any more unless my PM retires and some new PM requires me to try again as a condition of continuing opioid medication management. I personally consider the longterm use of steriods as more hazzardous than the longterm use of opioids.
Hey Daffydolphin,
AMEN! I could not have said it better. So many docs and clinics just wanting to schedule more and more of these money maker$ without regard for the long term effects on the patient.
I'm not saying I only want meds, but I'm concerned about these repeated injections - especially when I no longer benefit from them. There has to be other options for me. I, like you, will give in if I am forced to have injections for the privledge of continuing other care and/or meds with a provider. (What a crock - huh!?)
Thanks for sharing your opinion. I wish you the best with your cervical issues. Hope you continue to receive the care you deserve.
Thank you for the encouraging words about your physiatrist experience. He sounds like a wonderful caring doctor. You are truly blessed.
I have that type of PCP. She is so incredible. I never feel rushed, most appts last over an hour. But MOST important - she listens. She throughly explains everything and allows me to have input about my care. ((sigh)) Wish all doctors were like this. Especially PM.
I really appreciate your reply. I have had enough of the "injection happy" docs. I'm growing more excited about embarking on a new path for my PM. Thanks again and good luck with your continuing treatment.
Kay
The following user gives a hug of support to hillcountry63: Megonlegs (02-18-2013)
I'm so happy to hear that you've got a top notch doctor, too! It makes all of the struggling to find him well worth it and I wish all the folks in chronic pain around here could have the same experience
I had heard physiatrists don't do injections. (Though seems now that some do). I guess I'm hoping for a doc who will take more time to evaluate my problems and form a plan instead of just "experimenting" with various expensive injections. Obviously I don't completely agree with my former PM's assessment or treatment plan.
I'm open to trying different treatment options - just tired of being stabbed in the neck. I've even considered tapering off all the meds
Anyone have thoughts on the long term repeated use of steroid injections?
Hi hill country, I have seen a physiatrist for 12 years & he does not do injections. Last fall, he went rehab hospitalist full time. I had to see pm/ anes who suggested, no required ESI's, $2500 urine tox per month & agreed he "knew" my condition, but scheduled ESI's, they are contraindicated for me. On 2nd visit he tried to schedule ESI's again & reduced my meds & gave me 2 week supply in order that i keep procedure appt. I ran back to my old dr & he agreed no ESI's for me & i am blessedly back to my dr who cares, helps, & gives me my medicine. When looking for a new pm when he left to do rehab i found a description of a physical medicine & rehab, physiatrists breakdown of their practices & 50% acute & chronic pain & 50% rehab & restoring me to the highest functioning is the goal. I hope that this works out for you, of course i forgot to mention its a regular practice, no PT dept, one office, no traveling to a different office each day like many PM drs do but he will refer if he thinks that you need PT, cardiologist, etc. Im so grateful to God for him.
Last edited by gmak; 02-20-2013 at 04:18 AM.
Reason: typos, wording
I just ran into the downside of having a PM Doc that spends so much time with his patients LOL For the first time since I started seeing him, he was more than an hour behind schedule, and of course I brought my 3 yr old with me this time (I usually don't). Fun times!
I've been blessed that my primary care provider is also very giving of her time. If one of my kids is sick, she'll check out all 4 of them in the same visit. Never seems concerned about the cost of care - she just does it because she knows how expensive healthcare is now
... I found a description of a physical medicine & rehab, physiatrists breakdown of their practices & 50% acute & chronic pain & 50% rehab & restoring me to the highest functioning is the goal. I hope that this works out for you. Im so grateful to God for him.
Hi gmak ~
I really appreciate your response. Your description of a physical medicine doc is exactly what I'm looking for! I hope I find one who is as caring and helpful a yours. You are so very lucky you were able to get back with your original PM.
Isn't one of your conditions AA? That should be a no-brainer for NO ESI's. Geez...Some dr's are so "narrow minded" (aka $$$) these days.
My PM's have kept me in the same treatment routine for so many years... I really hope to find a fresh set of eyes who will start over. At least take the time to discuss my conditions and treatment options - and include me in the conversation. LOL
Hang on tight to your PM doctor - sounds like you have a great one.
It sounds like you too have a great primary care doc. I feel blessed to have mine. For routine things (thyroid med increases, etc) she will just discuss it over the phone - no charge. She trusts my judgement on simpe stuff and I truly appreciate that. It boils down to her taking the time to explain things to me.
I feel for you having to wait an hour at your PM appointment. This happens at my PCP frequently. But I don't mind, because I know I will get however much time I need with her - just like the last patient she saw.
I try to be knowledgable about my health conditions - obviously I haven't done a good job of that with my neck problems. LOL. Here's hoping a new physiatrist will take the time to educate me.
((hugs))
Kay
Last edited by hillcountry63; 02-21-2013 at 12:09 AM.
Reason: typos
You sound like me! I've learned the hard way that if I don't educate myself and fight for my right to compassionate care, I get what they give me ... which is generally subpar care that leaves me frustrated and in pain. I think my husband sometimes gets frustrated because my nurse practitioner is a little further than he'd drive if we didn't choose them as our pcp's and perhaps because I refuse to even consider moving until both she and my PM doc retire
What surprises me is with the number of doctors I've been to and the number of tests done, it took something like 10 specialists to figure out the problem with my lower spine and even more (my current PM doc) to figure out the problem with my neck! And of all of them, only my PM doc (other than the NP) that even took the time to examine me - and he does every time, without fail.
I often have to wait at my pcp, but like you said, it's worth the wait because I know she'll give me all of the time I need with her on a given day. She even sends us Christmas cards from her home address and has called me from home several times to discuss my concerns.
Hi gmak ~
I really appreciate your response. Your description of a physical medicine doc is exactly what I'm looking for! I hope I find one who is as caring and helpful a yours. You are so very lucky you were able to get back with your original PM.
Isn't one of your conditions AA? That should be a no-brainer for NO ESI's. Geez...Some dr's are so "narrow minded" (aka $$$) these days.
My PM's have kept me in the same treatment routine for so many years... I really hope to find a fresh set of eyes who will start over. At least take the time to discuss my conditions and treatment options - and include me in the conversation. LOL
Hang on tight to your PM doctor - sounds like you have a great one.
Blessings & ((hugs))
Kay
Hi hill country, Yes, i have AA & he, pm/ anes acted like he knew what it was but wouldnt download my MRI on his computer bc he said it made it crash & on appt #2 he actually told me what percentage he actually makes off of procedires & when i said contraindicated with AA he handed me the medtronic pamphlets on SCS & pain pump & told me getting ESI's next week & week after that give him my decision on whether i would want SCS or pump put in by a pm/ anes! Really, i have a disease where my spinal nerves are attached as one unit to my dura but im going to just arbitrarily let someone cut it, & 3 neurosurgeons @ Baylor wont touch me as long as patch & orals still work! $$$ & coersion, in my opinion! Plus, it didnt seem to matter what shape that i was left in! Have you found a solution? My son had a herniated disc while attending Concordia, the dr he saw did one ESI & it went back in!
He was a spine ortho but i dont think he did pain mgmt, Dr.
Gonzales? IMHO, i felt like if he, the dr i saw Not my son, was going to stick his neck out for me by prescribing narcotics that i had to pay for that priviledge with more money than an office visit. How do you ever see the dr to talk if you can only see him for procedures?
Last edited by gmak; 02-26-2013 at 10:59 AM.
Reason: typos& info
I'm so sorry you have AA I hope you are receiving adequate meds to keep you at a tolerable pain level and functioning. That's all any of us want. I have an Aunt who has terrible back problems. She hardly gets out and is not able to do the things she loves, like gardening. It just makes me sad to watch anyone lose their quality of life because docs are so afraid to adequately treat pain.
To answer your question about "how do I see my doc to talk...if they only schedule procedures?". Well, this policy went into effect at his new hospital clinic about 6 months after he moved. They made one exception for me since I had been at his private practice for so many years. My last appt. with him was when I was told "no office visits or follow-up, just procedures". So, that was my LAST appt. with him. If you take the communication out of the relationship between patient and doctor what is left? - $$$ - So my PCP has written me a couple months of Rx's while I search out a new PM doctor.
I so agree with you "$$$ and coercion" is what seems to be going on in some PM offices these days. I felt the same as you for a couple of years - that I had to keep getting the injections or he wouldn't write Rx's. They weren't giving me any added relief anymore and so expensieve. Then came the "just procedures" malarkey. Pbblltt to that!
I'm pretty sure the SCS would not be an appropriate choice for your condition - what was he thinking??! It doesn't sound like he really knows much about AA at all. (not that I do either, but I get the basics of it). I'm so sorry you had to put up with that MDumb.
I have not found a new PM yet - dreading the process of interviewing one after another that just has $$ in their eyes. I don't know what they can offer me, but I'm sure going to try to find another approach / treatment option to maintain a level of functioning and quality of life. I am trying to avoid a 3 level cervical fusion for as long as I can.
I am in kind of a similar situation as you. I have been to multiple PMPs over the years. I have had a pedestrian/car accident and 5 hi-speed motor-sports accidents. The car accident basically obliterated my lower right leg and has left me with more surgeries than anyone can count because of chronic bone infection (osteomyelitis). These surgeries included multiple external fixators, skin grafts, bone grafts, fasciotomies, debridements, and the absolute worst of all was a muscle flap/graft from my abdomen to my leg.
For a while I was able to deal with the leg pain and the primary reason for a PMP was the neck pain. Neck pain is from 5 motor-sports accidents all involving neck and back injuries and one major full body beat down (120MPH flip that ripped the car to shreds) the impact was bad enough that beyond a concusion the whites of my eyes where blood red then red and yellow for over a month.
Anyways the PMP started giving me injections and man that was great for my neck and it was at the same place most of the Rays get there injections done so he was a decent Dr but ALL they did was injections.
Anyways for me the injections where a HUGE MISTAKE because 9-12 months later BOOM I have a hole in my leg with puss coming out of it (not the first time but the first in 4 years). Infectious disease Dr said possibly excited by the steroids.
Either way if it was or wasn't nobody will ever know the infection spark a few extra surgeries and a near death experience.
On to the next PMP... about 2 years after the huge infection come back I am seeing an ortho because I am still having the infection flare ups. He is prescribes me oxycodone for the pain, starts upping the doses and eventually gets out of his comfort zone and refers me to a PMP. That PMP was a sport medicine PMP like the one that did the Rays players and he was all about injections which he quickly told me I was not eligible for DUH. He then tells me that oxycodone is has bad publicity and that he wont prescribe it. He tells me he will prescribe me hydrocodone and that it is the same strength per MG (NO IT ISN'T) and he also throw in some flexyril.
Finally a friend tells me about her mom's PMP so I go there. This guy was the FIRST PMP that did everything. He listened to me, prescribed me C2s, try doing nerve blocks in my leg, eventually got me to do the nerve stimulator implant (love it).
Now my insurance doesn't cover him and I am on the referral only and can only see people of a certain group type of insurance (HMO).
So today I have a visit with a PMP and I am so certain that they are injection only because all they could talk about was injection injection injection.
They already got approval for 2 injections from my insurance company and told me to have a driver FOR MY FIRST APPOINTMENT. Even though I told them several times I AM NOT GETTING AN INJECTION!!!
I don't have cancer but they say they treat cancer patients... w/ injections???
I will let you know how my experience turns out but what I am trying to get at is...
PMPs vary WILDLY and the ones that are attached to hospitals and the ones that primarily treat athletes are going to be very INJECTION INJECTION NO C2.
Even the PMPs that do offer a lot of C2s are sometimes a little too cautious about them which I totally understand but sometimes it is the right medicine and sometimes it is not.
I doubt I will find another PMP that is covered by my insurance that will look at me with an open mind but I will find out. I may have to pay out right to see my old PMP but if the insurance company doesn't fill his meds then I either have to go to methadone (which he will prescribe) or nothing...
What to expect from Physiatrist for PM ? 
I hope you are receiving adequate meds to keep you at a tolerable pain level and functioning. That's all any of us want. I have an Aunt who has terrible back problems. She hardly gets out and is not able to do the things she loves, like gardening. It just makes me sad to watch anyone lose their quality of life because docs are so afraid to adequately treat pain. 
