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Old 02-18-2013, 12:49 AM   #1
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Question What to expect from Physiatrist for PM ?

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.

Thanks in advance

Kay

 
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Old 02-18-2013, 04:23 AM   #2
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They are seem quite different around here.

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.

 
Old 02-18-2013, 08:44 AM   #3
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Re: What to expect from Physiatrist for PM ?

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?

 
Old 02-18-2013, 09:29 AM   #4
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Re: What to expect from Physiatrist for PM ?

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.

Last edited by Daffydolphin; 02-18-2013 at 09:33 AM. Reason: Add an opinion.

 
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Old 02-18-2013, 11:16 AM   #5
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Re: What to expect from Physiatrist for PM ?

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

 
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Old 02-18-2013, 03:59 PM   #6
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Re: What to expect from Physiatrist for PM ?

The only **physichiatrist** I ever heard of was Ricky Ricardo telling Lucy to go to the doctor?

Ferd144

 
Old 02-18-2013, 07:42 PM   #7
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Re: What to expect from Physiatrist for PM ?

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!

 
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Old 02-18-2013, 10:03 PM   #8
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Re: What to expect from Physiatrist for PM ?

Quote:
Originally Posted by no34evr View Post
..... 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 View Post
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.

Kay

 
Old 02-18-2013, 10:22 PM   #9
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Re: What to expect from Physiatrist for PM ?

Quote:
Originally Posted by Daffydolphin View Post
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.

Kay

 
Old 02-18-2013, 10:43 PM   #10
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Re: What to expect from Physiatrist for PM ?

Hello megonlegs ~

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

 
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Old 02-18-2013, 10:50 PM   #11
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Re: What to expect from Physiatrist for PM ?

Quote:
Originally Posted by ferd144 View Post
The only **physichiatrist** I ever heard of was Ricky Ricardo telling Lucy to go to the doctor?
Ferd144

LOL LOL LOL!!

I remember that episodel I'm a huge fan of "I Love Lucy".

Thanks for the laugh Ferd!

 
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Old 02-18-2013, 11:03 PM   #12
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Re: What to expect from Physiatrist for PM ?

Hi Kay,

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

 
Old 02-20-2013, 04:11 AM   #13
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Re: What to expect from Physiatrist for PM ?

Quote:
Originally Posted by hillcountry63 View Post
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

 
Old 02-20-2013, 02:57 PM   #14
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Re: What to expect from Physiatrist for PM ?

Hi Kay,

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

 
Old 02-20-2013, 11:51 PM   #15
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Re: What to expect from Physiatrist for PM ?

Quote:
Originally Posted by gmak View Post
... 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.

Blessings & ((hugs))

Kay

 
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