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    Old 01-23-2008, 11:49 AM   #1
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    Question Question about Pain Medicines and Doctors ???

    Hello Everyone. I have a few questions. First, do most of you see Pain Management doctors or General Practitioner docs? I ask this because I am having a terrible time with my Ortho doc giving me anything other than Ultram and one time Darvocet (crap) for my knee. I do not have a family doctor and know that alot of them are "against" narcotics while others are far better with them.

    I have many other problems that pain medicine would be very helpful with such as: Endometriosis, severe pelvic pain (hysterectomy scheduled for 2/18), herniated disc, severe left knee pain (had one surgery two years ago and ortho doc said total knee replacement in inevitable within 3 years), migraines and Sjogren's. So, I need a good doctor who will be helpful. I have had narcotic pain medicines before such as two weeks ago when I had to have my emergency appendectomy and they help with all the other pain pretty well.

    I know we are not allowed to ask specifics on this board but does anyone know of any good GP around Knoxville, Tennessee? That would be great.

    Take care all!!!

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    Old 01-23-2008, 12:17 PM   #2
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    Re: Question about Pain Medicines and Doctors ???


    I see my PM Doc for meds from my back surgery. I had a three level fusion, followed by my back breaking above the fusion the day after surgery. My surgeon was out of town for a week at a conference and of course the nurses and fill in staff didn't believe me when I kept telling them my pain was a 14 on a scale of 10. So they continued to get me up twice a day to walk with my broken back. When my surgeon returned, I was lucky enough to have another round of surgery to install 2 15" titanium rods and 20 screws. End results is that I will live with some degree of pain the rest of my life...oh and they hope I'll regain full use of my leg in 2-4 years with ALOT of therapy. SOOO I use my PM for the pain management from the back issues. He keeps me upright and pain controlled enough that I can work full time with a pleasant enough attitude that I don't snap people's heads off-most days.

    I have an internist/GP that I use for my day to day issues. He also recommended my accupuncturist when he felt the therapy wasn't enough for my leg issues from the back surgery. He has given me meds for the swelling in my leg and would, in a pinch help out should I need meds, but I don't use him for my pm issues. I keep them separate. My internist isn't against narcotics, nor would he be against prescribing meds for me to control the pain, but I just don't have to use him for that because of having the pm doc.

    My only issue with my PM Doc is that he doesn't accept any insurance so we have to submit him as an out of network provider. It takes extra work, but the benefit of having him outweights the extra work, especially as his staff does the submitting...

    Last edited by ibake&pray; 01-23-2008 at 12:23 PM.

    Old 01-23-2008, 01:50 PM   #3
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    Re: Question about Pain Medicines and Doctors ???

    I used to go to a PM doc but he was not providing me enough relief. Luckily, I found a GP doctor to go to that was willing to take over my pain management including all of my medications. I am currently on the fentanyl patch, ultram, trileptal, and lyrica. I am very grateful that he understands that, even though I am a recovering addict, that I should not be made to suffer. I manage my pain medications very carefully. It really sucks that I am living by myself and have to manage them by myself. I finally got a safe for Christmas and keep them locked up nice and safe.


    Old 01-23-2008, 03:23 PM   #4
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    Re: Question about Pain Medicines and Doctors ???

    I also see my regular GP for my meds, my last doc was also a general practice doctor.
    As I said in your other thread, Orthos are notoriously stingy with pain meds, If I were you, I would try and get with a primary, I think at the very least they can give you better relief than darvocet.

    Good Luck!

    Old 01-23-2008, 03:55 PM   #5
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    Re: Question about Pain Medicines and Doctors ???

    I won't go into my long story but my surgeon actually dropped me after a nerve block not before......I ended up going to my primary and he has been a blessing and has been helping me out since. In the beginning, I did not think it was going to work but I came to realize that he was testing me. Now he has told me that I have a legimate reason to be on pain meds. Duhhhhhh......4 back surgeries later and I still have major pain written all over my face.

    I am telling you this because be prepared any new doctor will probably test you first and they will more than likely start you on a very low dose in the beginning and build you up.

    I have also been reading alot about some pain mgmt doctors are not wanting to write the scripts either. But what I can't figure out is why there is pain mgmt doctors who don't write scripts. Isn't that there job???

    Last edited by ms_west; 01-23-2008 at 03:56 PM.

    Old 01-24-2008, 07:16 AM   #6
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    Re: Question about Pain Medicines and Doctors ???

    I have also been reading alot about some pain mgmt doctors are not wanting to write the scripts either. But what I can't figure out is why there is pain mgmt doctors who don't write scripts. Isn't that there job???

    No, Writing scripts for opiates is not a pain management docs duty, there are dozens of modalities to treat pain that can be tried before you have to trade opiate dependence for pain relief. Yes pills work but so do some of the other methods that are used in pain management, If you don't try those other methods you will never know if your pain could have been managed without that horrific cost.

    To answer the original poster, I see PM docs, anesthesiologists. neurologists, Do's, Physical mediecine docs that have specialized and became board certified because there are things other than opiates that PM docs have at their disposal that your GP will never offer. I like knowing my docs know what they are doing and can offer more than what they just learned from a pharamcuetical rep.

    If I had cancer I would go to an oncologist, If I had a broken leg I would want an ortho to reset it and for intractable pain, I want a specialist too. A GP has one tol to ofer. A PM doc should have dozens of options and the one your seeing doesn't, the next one will know use a technique the first wasn't trained in. What methods of pain intervention aside from pain meds and the drugs a rep is selling and giving away has your GP been trained in.

    Just because a doc is comfortable prescribing meds he knows nothing about doesn't mean your recieving top of the line care, your simply recieving what you ask for. If all you want is pain meds, sure your doc can supply them right up untill he's no longer comfortable doing so. The idea that because we have paid a copay to a PM doc means we are entitled to 24/7 attention and all the pain meds we ask for is completely absurd and shows a level of entitlelement that's never been seen in medecine.

    That sense of entitlement is why some will never benefit from decades of experience in Pain management because the patient now thinks they know more than the docs because they read about a pain med they haven't tried. Many PM docs still believe Opiates should be the last line in pain management. Dependence is a huge price to pay both short term and long term, when trained PM docs have dozens of other options. A GP has no other option. He isn't trained to do anything in PM other than write a script.

    A PM docs job is to manage pain and help people learm to cope with pain that can be eliminated, not to supply enough meds to stop everyone from complaining or prevent people from having to adjust their lifestyle to their new condition.

    Personally I like knowing my docs are board certified in their specialty and pain managamanet. They learned what they know from years of education, internships, fellowships, the certification process and clinical practice with the meds they prescribe.

    Or you can shop for a GP wiling to prescribe the meds he just learned about from the hotty rep in 5 minutes that knows nothing more about the meds they hustle than you can be read in a patient insert.

    JMO, Good luck, Dave

    Old 01-24-2008, 01:14 PM   #7
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    Re: Question about Pain Medicines and Doctors ???

    I understand a lot of your points Shoreline about having "specialty" doctors. I have over the last 7-8 years seen a Rheumatologist for my Sjogren's and went through all types of drugs including cancer drugs which left me very sick. I have seen a different ortho doc for my back and went through 9 epidural and caudal blocks for the herniated disc. Each block worked well for about a month and the pain came back. I have had knee surgery and went through physical therapy (which did not help). So believe me I have been through alot of other means for pain relief. I am not one that loves narcotics, although they do help with the pain, they have their drawbacks as well.

    I do believe there are good GP docs out there that know a lot more about pain relief than just writing narcotic scripts.

    Take care all!!

    Old 01-24-2008, 07:48 PM   #8
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    Re: Question about Pain Medicines and Doctors ???

    Dave, you make some valid points and I always enjoy reading your posts. I have to disagree with you just a bit in my case. I may speak for others here, also.
    I have adhesive arachnoiditis, which can be brought on by trauma, back surgery, ESIs, spinal taps, myelograms and other invasive procedures. My treatment can ONLY be palliative care-no injections, vigorous PT, further back surgery, etc.
    I was sent to PM by a neurosurgeon after having been diagnosed with AA by him after I had finally diagnosed myself after a long, painful ride on the healthcare merry-go-round. The PM docs seemed to have no clue on how to treat AA, even pushing epidurals which are verboten! Their only other idea was an SCS-a 16K+ procedure that they wanted me to commit to right off the bat. They seemed to be pushing expensive procedures while not considering conservative measures of pain control. This, coupled with a dirty office and an assembly line atmosphere turned me off.
    I went back to my PCP and told him of my experience and my PCP told me not to go back and that he would make sure I had the care I need, including meds. This has made my life much more simple and happy. I know my experience in PM is only one person and one PM practice, but it left a bad taste in my mouth. I'm very blessed in having a wonderful PCP who is involved in my case and don't doubt that many others have gotten benefit from PM. Just want others to keep in mind that PCP care is not necessarily second-rate care. Thanks.

    Old 01-25-2008, 05:25 AM   #9
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    Re: Question about Pain Medicines and Doctors ???

    I want to add that on my rather well known HMO plan, PM docs do not write scripts. You have to see a pm and they give input to my primary who then in turn writes my scripts.

    I will also say that my primary is not the most educated on the nerve medicines and the antidepressents but when I was in last time, he called a neurologist on the spot for advice. He then came back in and said, I am going to talk to the head pharmicist and the psychologist concerning adding a nerve med and antidepressent and get back to you. I need to check on a couple of things since you have had some serious reactions to nerve meds in the past. I was very impressed with the fact that he admitted he did not know everything but was willing to research it. So I agree they don't know everything.

    Old 01-25-2008, 11:26 PM   #10
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    Re: Question about Pain Medicines and Doctors ???

    I have seen my fair share of doctors -- neurologists, neurosurgeon, ortho, etc. They all seem to have no problem prescribing meds for me but only for a few weeks after a procedure or operation. Then they have always told me to go to my GP or PM physician for continued care.

    If you feel that your condition is of a chronic nature, and if your docs agree, I would suggest you start looking for a good Pain Management physician. I have seen a few over the years and they have all been quite helpful. Some were limited as to how much they would get involved with my care, others tackle it all. My current PM is a PM doc as well as a Neurologist. This is a great fit for me because it saves me from having to see a different doctor for my neurological needs.

    So, I would ask around and find a PM that can handle much of your needs, or at least be the quarterback to your other docs - if you know what I mean.

    I have not found a GP that was ever willing to prescribe me the type of meds I take, and I sometimes wonder why a GP would take that risk - if it is a risk, not sure. I just assume that when it comes to working out different types of meds to get your pain down that a PM is the best way to go...

    Just my 2 cents.

    Hope it all works out,

    Last edited by camw; 01-25-2008 at 11:27 PM.

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