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    Old 02-08-2016, 10:18 PM   #1
    Eva 14
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    Question How to Find New Pain Doctor?

    I just found out that my long-time pain doctor is retiring. I've been seeing him since 2009 and he's been great; very compassionate and prescribes whatever I need for pain and sleep. I have excruciatingly painful severe intractable migraine, which is totally debilitating. With pain and nausea meds, I'm able to function at a basic level. Without pain meds, my pain is so severe that I'd be unable to get out of bed....I don't even want to think about the agony.

    In the past 25 years, I've been to neurologists, headache clinics, etc. and no one can help me. I've tried dozens of preventatives, DHE IV, ergots, triptans, Depakote, magnesium, feverfew, prednisone, Neurontin, Topamax, Toradol, Nubain, lidocaine, etc.---all to no avail. Opiates control the pain so that I'm at least able to go grocery shopping and perform other basic chores.

    My pain medication regimen is rather complex. I take a long-acting pain med, as well as a few different short-acting pain meds for daily breakthrough pain. I also take anti-nausea meds and sleeping pills.

    The stress of losing my trusted pain doc and the daunting task of trying to find a new doctor is causing my pain levels to spike terribly. I just went for a regular appointment and BAM---I'm told he's retiring. It's basically my worst nightmare; I truly do not know how I will cope or what I'll do. I don't have anyone to take care of me, so that makes things even worse.

    In 25 years of chronic migraine, I have definitely encountered my share of clueless, unsympathetic, and even downright hostile doctors. (I've had a few nightmarish experiences at the E.R.). I know what it feels like to not be believed or to be treated like a 'drug seeker'. I've also had doctors who told me to just 'relax'! Migraine is neurological, not psychological, but some docs truly don't understand that. And there's no test to 'prove' migraine, so docs can always accuse migraine sufferers of lying to get drugs. And too many people dismiss migraine as 'just a headache'; they don't understand how disabling this condition can be.

    How does a person in severe pain find a new pain doctor? I live in a major metropolitan area, but there still are not many pain docs around. Do you look for someone board certified in anesthesiology? My pain doc is an anesthesiologist, and I thought that these were the best pain docs. But my pain doc says things have changed even in the past 10 years. He says anesthesiologists nowadays are doing 'procedures' and 'interventional medicine' instead of prescribing pain meds.

    I always liked going to a pain specialist vs. an internist. For years, neither my internist nor my neurologist did much to treat my pain. I suffered so much and I was so relieved to finally find a great pain doc.

    My pain doc says an internist can get certified in pain management, but are they really as good as a pain doc certified in anesthesiology? I like the idea of seeing a pain specialist.

    My pain doc gave me a list of a few doctors' names. I already know that one doesn't prescribe opiates, and I know that another one has a terrible reputation for treating CP patients like drug addicts. The only one left is an internist who also happens to be an addiction medicine specialist AND a chronic pain specialist. I know this doctor will prescribe opiates, but I have no idea if he will understand or agree with my complex medication regimen.

    My pain doc ONLY saw chronic pain patients, and it was a high-class clientele. The internist/addiction/chronic pain doctor sees all three of the aforementioned types of patients. So he's got regular people coming in for physicals, some pain patients, and a lot of opiate/heroin users who are there for the Subutex detox.

    This internist is really well-known for the Subutex detox; addicts from the city come to him. It's fine that this doc is helping junkies overcome their addictions, but I also would think that things might get a bit confusing for this doc. I'm afraid he might start to think of his pain patients as 'addicts'?

    It seems rather strange for a doctor to simultaneously be an addiction medicine specialist AND a chronic pain specialist. (I have read some reviews that state that this doc does indeed treat his pain patients like drug addicts). I'd also think that the drug addict patients would be 'envious' of the pain patients who are getting scripts for narcotics. In particular, my most powerful and effective pain med would be like 'gold' to a junkie.

    Can anyone please offer ideas for how to find a good pain specialist? And once at the initial appointment, what is the etiquette? Is it okay to list my medications and tell the new doc how much my former doc would prescribe for me per month? In 25 years of migraine, I've come to know what I 'need' to feel comfortable. It's a bit awkward to say I 'need' a certain medication (or form of medication) but it's also the truth. Could I say, "This medication works best; I take three per day?"

    Thanks for any advice. I'm scared and in severe pain. I just want to be able to get the meds I need to feel somewhat comfortable, but I'm afraid I won't be able to find a new doctor who will agree with my current regimen.

     
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    Old 02-09-2016, 12:09 AM   #2
    ARANGER
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    Re: How to Find New Pain Doctor?

    Hi Eva,

    First let me say I'm sorry you're in this position of having to find a new pain doc. That alone can cause stress, and as we all know, stress can cause pain. I've actually been in this position myself and it did take a while and thank God I found a compassionate doctor. But that was not without a bunch of stress and visiting Doctors that treated me bad and basically wasted my time.

    A lot has changed in the pain management world. Pain docs are moving away from prescribing opiates especially high doses. Even people that have been with their docs for years are finding reduced prescriptions and docs using other modalities of treatment. Many people on here have seen their dosages reduced with their same doc. So be prepared for a difficult journey; sorry for bad news.

    My advice would be to first talk with your current doctor who knows you and your conditions. Maybe he knows of a doc or can even recommend/call a doc about you. Second, I would gather as much documentation of your conditions and your current treatment plan and have that with you when you visit new doctors. At least they will be able to see that you've been an established patient, no red flags, etc. But again, don't go in expecting the same treatment plan.

    Be willing to accept new modalities of treatment with a new doctor even if you've done them before. Many docs want to see that you're actually trying to reduce the pain and not just there for pills. It may also build up a trust with a new doctor that your end goal is to reduce your pain and if they say they have a new trick up their sleeve to achieve that then great. Doctors like to document that you've tried everything to help, and maybe in the end Opiates are the best bet. But you've got to be willing to try. I also wouldn't go in demanding this med or that. Many time a first consultation is just about your medical conditions. Meds many times come in later visits.

    I'm sorry you've got to start this process. Just make sure you're prepared with medical info, getting referrals for your current doc, and be ready to try new things. But in this day and age, docs are prescribing less and it seems like something the chronic pain community is having to get used to.


    Sorry you're in this position; I know from experience how stressful it can be. Do your research and have all your ducks in a row before seeing other docs. I hope you find a great compassionate doctor that will treat you effectively.

    Best of luck to you

     
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    Old 02-09-2016, 05:16 AM   #3
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    Re: How to Find New Pain Doctor?

    Sorry you are going through this. Unfortunately many areas are like yours, with a limited selection of pain doctors. Since you likely only have less than a month, I'd recommend going with the best option on that list and making an initial appointment. Be open to new ideas as any new doctor is likely going to want to make tweaks to your regimen, no matter how stable you are, just based on their personal preferences. Later on you may be able to find a better fit, but you really need to get in with someone ASAP as its likely they won't prescribe any meds until the second visit (they usually wait for a UA to come back). Plus the wait time may be long now that your doctor is having all his patients need new doctors.

    On the first appointment you'll present your current medication list (I'd also bring in all the current bottles, ensuring you have the correct pill counts). On it, list the medication, dose, frequency, doctor who prescribes it, how long you've been on it, and what you take it for. I'd also bring in a list of every treatment you've tried previously (with dates, doctors, and doses if you have the info). They will likely ask for that as part of their new patient paperwork. The doctor will take it from there as far as what they think is an appropriate treatment. Answer any questions they ask, but you don't need to offer up explanations for your dosages or ask for certain meds or dosages. Having an organized medication list and history will help a doctor justify prescribing for you.

    Keep in mind that it may be very difficult to find a doctor willing to prescribe opioids long term for noncancer chronic pain, especially if you are on higher dosages, as they are moving away from it. In your situation I would start to taper to extend the amount of time I'd have to find a new doctor. I wouldn't get too caught up in the type of doctor or their patient population. Its ok to make multiple new patient appointments if more than one doctor is a good possibility, to hedge your bets, as long as you don't get meds from more than one doctor or sign more than one contract. Also ensure you request your medical records from your old doctor. Read over them and try to have them correct any errors before they close up the office. You'll likely need the records for your new doctor anyways. Hang in there! Good luck and best wishes.
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    Old 03-24-2016, 10:30 AM   #4
    TDunkin
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    Re: How to Find New Pain Doctor?

    Quote:
    Originally Posted by Eva 14 View Post
    I just found out that my long-time pain doctor is retiring. I've been seeing him since 2009 and he's been great; very compassionate and prescribes whatever I need for pain and sleep. I have excruciatingly painful severe intractable migraine, which is totally debilitating. With pain and nausea meds, I'm able to function at a basic level. Without pain meds, my pain is so severe that I'd be unable to get out of bed....I don't even want to think about the agony.

    In the past 25 years, I've been to neurologists, headache clinics, etc. and no one can help me. I've tried dozens of preventatives, DHE IV, ergots, triptans, Depakote, magnesium, feverfew, prednisone, Neurontin, Topamax, Toradol, Nubain, lidocaine, etc.---all to no avail. Opiates control the pain so that I'm at least able to go grocery shopping and perform other basic chores.

    My pain medication regimen is rather complex. I take a long-acting pain med, as well as a few different short-acting pain meds for daily breakthrough pain. I also take anti-nausea meds and sleeping pills.

    The stress of losing my trusted pain doc and the daunting task of trying to find a new doctor is causing my pain levels to spike terribly. I just went for a regular appointment and BAM---I'm told he's retiring. It's basically my worst nightmare; I truly do not know how I will cope or what I'll do. I don't have anyone to take care of me, so that makes things even worse.

    In 25 years of chronic migraine, I have definitely encountered my share of clueless, unsympathetic, and even downright hostile doctors. (I've had a few nightmarish experiences at the E.R.). I know what it feels like to not be believed or to be treated like a 'drug seeker'. I've also had doctors who told me to just 'relax'! Migraine is neurological, not psychological, but some docs truly don't understand that. And there's no test to 'prove' migraine, so docs can always accuse migraine sufferers of lying to get drugs. And too many people dismiss migraine as 'just a headache'; they don't understand how disabling this condition can be.

    How does a person in severe pain find a new pain doctor? I live in a major metropolitan area, but there still are not many pain docs around. Do you look for someone board certified in anesthesiology? My pain doc is an anesthesiologist, and I thought that these were the best pain docs. But my pain doc says things have changed even in the past 10 years. He says anesthesiologists nowadays are doing 'procedures' and 'interventional medicine' instead of prescribing pain meds.

    I always liked going to a pain specialist vs. an internist. For years, neither my internist nor my neurologist did much to treat my pain. I suffered so much and I was so relieved to finally find a great pain doc.

    My pain doc says an internist can get certified in pain management, but are they really as good as a pain doc certified in anesthesiology? I like the idea of seeing a pain specialist.

    My pain doc gave me a list of a few doctors' names. I already know that one doesn't prescribe opiates, and I know that another one has a terrible reputation for treating CP patients like drug addicts. The only one left is an internist who also happens to be an addiction medicine specialist AND a chronic pain specialist. I know this doctor will prescribe opiates, but I have no idea if he will understand or agree with my complex medication regimen.

    My pain doc ONLY saw chronic pain patients, and it was a high-class clientele. The internist/addiction/chronic pain doctor sees all three of the aforementioned types of patients. So he's got regular people coming in for physicals, some pain patients, and a lot of opiate/heroin users who are there for the Subutex detox.

    This internist is really well-known for the Subutex detox; addicts from the city come to him. It's fine that this doc is helping junkies overcome their addictions, but I also would think that things might get a bit confusing for this doc. I'm afraid he might start to think of his pain patients as 'addicts'?

    It seems rather strange for a doctor to simultaneously be an addiction medicine specialist AND a chronic pain specialist. (I have read some reviews that state that this doc does indeed treat his pain patients like drug addicts). I'd also think that the drug addict patients would be 'envious' of the pain patients who are getting scripts for narcotics. In particular, my most powerful and effective pain med would be like 'gold' to a junkie.

    Can anyone please offer ideas for how to find a good pain specialist? And once at the initial appointment, what is the etiquette? Is it okay to list my medications and tell the new doc how much my former doc would prescribe for me per month? In 25 years of migraine, I've come to know what I 'need' to feel comfortable. It's a bit awkward to say I 'need' a certain medication (or form of medication) but it's also the truth. Could I say, "This medication works best; I take three per day?"

    Thanks for any advice. I'm scared and in severe pain. I just want to be able to get the meds I need to feel somewhat comfortable, but I'm afraid I won't be able to find a new doctor who will agree with my current regimen.

     
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