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    Old 06-15-2005, 03:20 PM   #1
    ARANGER
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    Does anyone see a pain management Dr.

    If you look back at my posts you will see my ongoing battle with Fibro. I have had three Dr's tell me that they believe I have Fibro and I have been diagnosed by two with widespreed Chronic Myofacial Pain.

    Well I had good news when my Dr. refered me to a Rhuemy. Well they just called and I can't get in until the end of August. I can't wait that long. I have so much pain and fatigue. So I called a Pain Dr. today who can see me in a few weeks.

    Does anyone else see Pain Dr's.? I just can't wait two months.. I hear about these flare ups, how long do they last? I've developed the worse pain in my legs and more fatigued by the day. Do they last a couple of weeks? I'm not sure what to do. I don't know if the pain Dr is the right one to see but I'm not left with a whole lot of options. This seems to be progressing at a daily basis. I'm recovering from surgery on my back so I take Lortab 10/500, but its more than that. The fatigue is killing me. My wife and i are having a baby and it is due in less than a month. I don't know what to do.

    There has been days that I have considered checking myself into the hospital. I just don't know what to do. My fatigue and pain is so bad, I lost all balance and fell into a wall and then to the floor. Its getting bad. Any suggestions would help greatly.

    Thanks

     
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    Old 06-15-2005, 03:40 PM   #2
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    Re: Does anyone see a pain management Dr.

    wilson , so sad to read of all you have going on.
    I see a PM but I have spine problems and that is what I go to him for, he doesn't even write my scripts though most do, My GP is the one I have write all my meds, I have been on pain meds now for almost 6yrs and am being considered for the pain pump.
    I was diagnosed with "possibly" having lupus and FM in Feb. but so far nothing has been done about the FM though I did start on plaquenil for the lupus.
    It sure couldn't hurt to try and see a PM dr. but just like with all the other drs it's not always easy to find a good one.
    I have dealt with the symptoms for so long and for so many reasons I'm not sure what is causing what anymore and the drs aren't either.
    I never would have believed it but I started a time realesed B complex supplement and can not believe how it is helping with the fatigue, I'm not saying I'm full of energy and back to where I once was but I can sure tell a difference.
    Congrats on the baby and I hope you can get some releif and help soon.
    Linda

     
    Old 06-17-2005, 12:21 PM   #3
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    Re: Does anyone see a pain management Dr.

    hello wilson, pain docs are pretty good for us if you find one that works and can help you. i have already seen 2 and have an appt with one soon. they have a number of things that they can do and reccomend for people with chronic pain.
    they also know about different meds that might help and you might be able to try so you can get some relief.
    good luck and keep us posted.
    love,
    robin

     
    Old 06-17-2005, 12:57 PM   #4
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    Re: Does anyone see a pain management Dr.

    Hi Wilson,

    Do you have a GP you see who you could get into and tell them that your wife is expecting, you have an appointment with a PM, but in the meantime you need help. That would be my first step, use what ever doctors who know you now. I would also call the surgeon and/or your ortho and tell them that you are falling, this is dangerous and you want to make sure the surgery is not causing something unusual.

    After going to many different doctors I went to a Pain Managment doc and he has been the most wonderful, understanding and compassionate man I have met in a long time. If you get a good one they can be wonderful. Some of them are also anetheseslogists so they have the credentials to do shots for pain when it applies. A good one should know the latest medications that can help you.

    For me there is only one in my area, I sent the paperwork and he accepted me feeling he could help me. I have fibro and 2 hernitated discs in my neck. He is the doctor I trust for all of my pain managment and I do not see my GP unless I have a cold or flu. A good PM will not necessarily give you opiods, there are other things out there, however, mine is not adverse to doing what is necessary.

    Anyway, enought about me. I would call the office of the PM you have the appointment with and tell them your situation and see if you can get in earlier. I have found that many times they can fit you in. I worked in a doctors office once and we always left openings everday for emergencies such as yours. They also might be able to get you in sooner if you explain how serious your pain is, your wife is pregnant and expecting SOON. Worth a try. Call every day to see if they have a cancellation. Do everything you can to try and talk them into it. Be as sweet as you can be which I am sure you are. Even if he is not the right PM for you, at least you might be able to get in and see what he can do for you.

    It sounds like you are really suffering and if you are considering going to the hospital, you need some pain control. I hope you are able to find someone to help you. Your wife and baby will need you. Try not to stress to much about it, easier said than done I know.

    Sorry you are suffering so much. By the way, congratulations on your baby, what happiness that will bring. This is a time that you need the help of doctors so please do what you have to. You need relief for yourself, your wife and your new bundle of joy.

    Let us know how you are. Sending energy and prayers that it will work out.

    Peace and love, Janet

     
    Old 06-17-2005, 01:49 PM   #5
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    Re: Does anyone see a pain management Dr.

    Hi wilson,

    I was dx'd with FM by a Rheumy back in March '02 and then I was referred to a Pain Management doc in Sept '02 because of lower back pain.

    I suggest that you see BOTH. The Rheumy will prescribe you meds that the Pain Doc usually doesn't, though it depends on the type of Pain Doc or clinic you see. Pain docs are usually great. I absolutely love mine. They are concerned about treating PAIN, period, no matter what type it is, they do their best to make you more comfortable with what ever modality they can. Be that Physical Therapy, Medication, Injections, and even sometimes referring you out to a mental health doc. Some Pain Clinics are different than a Pain doc who is in private practice. Mine is in private practice.

    A Rheumy will address your whole musckulalskelatal system, since FM is a connective tissue disorder. Though the problem with most Rheumy's is that they will NOT prescribe narcotics for the pain of FM. They believe that there are other ways to treat the pain from FM. You may get Ultram from a Rheumy, but that's about it. Though, encouraging Rheumy's to prescribe narcotics for the pain of FM is a hot topic in the medical community, usually discussed at Rheumatological conferences, but so far nothing has changed much, unfortunately.

    When you DO get to see a Pain doc you will be asked to sign a contract (most likely) stating that you will not get any narcotics except from that doctor. Also that you are responsible for lost or prescription mistakes made at the pharmacy. i.e. You get home and discover that the pharmacy has not given you enough meds, or give you the wrong kind. Always check your meds AT the pharmacy. Most pain docs or clinics will NOT replace lost meds, they will not allow phone in refills, and most will not call the pharmacy to fill a med. Depends on the doctor and the clinic. The DEA monitors Pain docs and Pain Clinics very closely these days. Most prescriptions (schedule II meds) are to be filled on a monthly basis, meaning you will not get any refills on your narcotics. You will have to see your doc every month to get your refill. Not all meds fall into that catagory, but a lot do. This is a recent change that the DEA has strongly "suggested" that Pain docs and clinics follow. Used to be, you'd go in for your refill appt with your Pain doc and he/she would write you a script for your meds dated the day of your appt and write a separate script (depending on the class of the med, you'd either get one or two extra scripts). This extra script would be for the same med but with a DO NOT FILL UNTIL date on it. So when your first script ran out you'd simply take your other script to the pharmacy on the day it is supposed to be filled and get it filled. This saved on the amount of appts you'd have to go to your Pain doc for your refills. Well, in January of this year the DEA put a stop to all "multiple scripts" written on Schedule II meds.

    In some cases the pain of FM warrents narcotics, some don't.Some FM patients don't need narcotics for pain. It depends on the person. Personally, I think narcotics should be given to certain FM patients without hesitation as long as that person's life is severly disrupted by that kind of pain. And if that person's history is clean and they can handle opiates. Not everyone can take opiates.

    And I can tell you this, it may take a lot of trial and error to find the right pain medication "cocktail" for you. But it's worth the time when you finally find a medication that will give you relief. A common misunderstanding regarding pain meds is that they will stop ALL the pain, they don't. Becoming totally pain free given your conditions along with FM won't happen. The goal of the Pain doc or clinic is a 50% reduction in pain for each individual. There are a lot of pain meds out there and you will most likely always start low, then increase. Increases in your dose may occur frequently when you first start using narcotics. Do not be afriad to tell your PM doc that what you are using isn't working. They WANT to know, or they can't help you.

    There are a lot of rules and regs that go with Pain Management, but as long as you aren't "difficult" you will be treated well. You can get "fired" from a Pain Management Clinic or Physician. You also may have to submit to random drug screens. Urineanalysis. This is done just to make sure that the meds you are being prescribed by your PM doc are in your system. I've only had to take one in three years. There it another poster here though, that has had to submit one more often, and this poster also had to take a "class" about narcotics given at her PM clinic. Pain docs are great, but they are docs, and they are all different, for sure. But for me and for most, IMO, they are a God send. My Pain doc has been in pain before due to an injury/illness and he understands pain cuz he's felt it. I like that.

    You will still, IMO, need the care of a Rheumy, tho don't be suprised if you have to go "through" a couple before you find one that you are comfortable with. I don't mean to scare you, I'm just stating the commonalities that a lot of us here have had to go through regarding Rheumy's. They ALL have their own take on FM. Which is so dern frustrating, but you will want a Rheumy you feel comfortable with because most likely, your relationship with this particular doc will be a long one, same with a Pain doc.

    I would also like to tell you that most likely you are experiencing SO much FM pain right now because of your surgery. I found a place online that goes into great detail about how a person with FM will react to surgery and it also had a set of "instructions" as far as increasing your pain meds before surgery and that the surgeon should know that you have FM and there fore may need more meds during and after surgery. Your recovery will be different than that of a "normal" person without FM. We recovery slowly. Very slowly. We catch a cold or an infection of any type and it takes us twice as long to recover, because our immune system is compromised. Also we will experience more pain than someone who doesn't have FM when we are ill or injured. Our brain does not have the capacity to "fight off" pain receptors like a "normal" does. That area of our brain does not work properly, and our neurotransmitters are out of whack, so pain transmitters are allowed to continue "transmitting" pain even when the pain really isn't there. It's called "phantom pain". Once our body has been injured, i.e. surgery, the neurons that usually block pain have been damaged because of the FM, so when we feel pain from the injury or the surgery, it "sticks and stays" in our system, even though it really isn't there. Confusing, I know, but what our body is "reading" is the pain as though your surgery happened yesterday. Our body's CNS can't "dissolve" the pain naturally, it doesn't have that function with FM, so the pain remains, even after you are "healed".

    more...CONTINUED ON NEXT PAGE:

    Last edited by tkgoodspirit; 06-17-2005 at 02:45 PM.

     
    Old 06-17-2005, 01:55 PM   #6
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    Re: Does anyone see a pain management Dr.

    CONTINUED:

    Now, about your flare. You are in a huge flare now because of your surgery. The surgery caused you to flare. We have another member here who just had a very serious surgery done and she is now in a huge FM flare. FM just LOVES surgery, it "feeds" off of it. This flare may well last until your body has healed as best as it is going to. Be prepared for that. I'm sorry, I know this is not what you wanted to hear, but I can't sugar coat it for you. Make sure you take your pain meds when you need them, DO NOT be brave and "ride out" the pain. Also, rest rest and REST. Your flare won't subside unless you do. Get help if you need it, do not be a "hero". Your body is special and you need special care, especially now. Try some supplements that may help your FM pain, like Malic Acid or other "homeopathic" anti-inflammatory supplements. Look 'em up on your computer and be sure to ask your doc before you use any kind of supplemental amino acid, vitamin, or anti-oxident out there. Getting more of what us Fibromights are missing into your body right now is important to help you get through this flare.

    Flares will last an unusually long time when we are injured, recovering from surgery, we are ill, or suffering from excessive stress. Also, TRY and keep your stress at a minimum. I know, that is probably one of the hardest thing for us to do, but it IS important during a flare particularily.


    Usually a flare will last anywhere from a few days, to a few weeks. Depends on the person, and what caused the flare. Everyone is different. Did I say REST? Rest is one of the most important things you can do when you are in a flare. If you can tolerate it, see about getting a whole body massage. It will help you. If you can't get out, some massage therapists will come to your house. You may have to pay a little bit more, but it may be worth it to you.

    So, I'm truely sorry that you have to wait so long to see a Rheumy and a Pain doc. I have never had a problem getting into see a Rheumy, but I hear so many stories of people who do. I don't know why that is. I live in lower Alabama right on the state line of Florida and most of my docs are in Pensacola Florida across the state line. I have to travel quite a distance for most all of my docs, cuz I live in the country, but I have like 3 or 4 fair to large sized cities, maybe that's why I never had a problem seeing a Rheumy. And I've been through 3 Rheumy's so far! Maybe because down where I am is a HUGE retirement and "snowbird" area. We get all the "cold weather" folks in our winter, then in the summer we get a lot of vacationers. We have a lot of retired folks here, and there are a lot of hospitals and docs here!

    I DO know that it can take awhile to get into see a Pain Doc. It took me about 4 weeks, that was in 2002 and before my doc went into private practice. He used to be part of a Pain Management department at a clinic that sits adjacent to one of the big hospitals. He was rather "radical" and was referring his patients out to private MRI facilities cuz they were cheaper, instead of sending them to hospital's MRI dept, and when the MRI films came back he'd give them to his patients instead of having them kept at the clinic's records dept, which was clinic policy. So, he went out on his own, thank GOD! LOL But I think he is more busy now than ever, so it probably is hard to get in to see him now. I think he has over 1000 patients he treats on a regular basis!

    You have to remember, Pain Doctors are in high demand. And it is a fairly new practice really, so we don't have that many Pain specialists, if you look at the big picture. And the DEA makes it so difficult for these docs that I believe med students are discouraged from going into that specialty.

    If I were you wilson, I'd do my best to wait it out and get into see these two types of docs. I don't think you'll regret it. And once you're in, you're in. 'Til then, rely as much on your surgeon and your GP for the pain relief you need until you can see one of those docs. K? Hang in there. It's tough, all of us here KNOW that, and we are here for you when you need us. Please keep us posted.

    Hang in there.
    tk

    P.S. You may want to check out the Pain Management board here and just read some of the threads there to familiarize yourself with Pain Management care. I post there a lot because of my back and other conditions, but I have learned a lot about different pain meds there that I was able to discuss with my Pain doc. FM and Pain go hand in hand. Posting here on the FM forun is the best for me, but I "supplement" my needs on the PM board from time to time! Just an idea.
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    Old 06-17-2005, 04:32 PM   #7
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    Re: Does anyone see a pain management Dr.

    Wow, thanks for all the info...Much appreciated. You all have shared much needed info and THANK YOU. And TK, you seem to have especially a wealth of knowledge.

    I have kept my appt. with the rhuemy but am also going to see the pain Dr. I'm currently in a contract with my surgeon and will not violate it. I will ask prior that it is cancelled.

    The funny thing is about pain management, is because of my profession (and I know I can't reveal exactly what I do) but I have been classifed as an expert in Drugs (I'm not a drug dealer...lol). I work for the other side. Anyway, I have a ton of knowledge about drugs and how they work and what metabolites they turn into after taking them etc. I went to a lot of school to learn that stuff. But its more that. I'm not just after taking a pill. Like many of you said, Its finding out what works. Kind of the whole package.

    This Fibro thing is new to me. It's a different type of pain and feeling. I'm also a male so I'm in the "minority" for Fibro. I've had Dr's tell me "Oh it only effects women" or "Thats a wastebasket diagnosis." So its been difficult, and I have seen many Dr's and saw the looks on there face's when I mentioned it. Finally a Physiatrist (Pain Specialist), a Chiropractor, and especially the Family Doctor belived it. He told, "I'm sure you havfibromyalgia." He was the one to refer me to the Rhuemy. I called and made the Pain Dr appt and asked if they treat FM patients. They said yes, so I'm crossing my fingers.

    As far as the flare up goes. I think this was the first "Major" one I had. I have had several times where I don't feel well, but this one did me in. I think its starting to subside finally. After having this Flare Up, I have a whole new respect for all FM patients.

    So in ending, I appreciate all the advise and am going to act on it. I think a mixture of Dr's, massage, medications, exercise, and B-12 thing. I'm going to try it all. I may be asking for some advise about FM from all you because you have dealt with it for many more years than I. If you have some questions about your pain meds, I may be able to give some advise there to someone who needs it. And Tk, I do post on the Pain Board, and read it daily and try to answer questions. I usually see you there too. Again, thanks to everyone, I'll keep you posted on the results. Until then, hope everyone is feeling well. I'm still in shock that so many people have to have so many problems getting the diagnosis. It bothers me, but I guess thats the way things go. It sounds like it is changing though.

    Thank you and good health to you all.

    Last edited by wilsontpd; 06-17-2005 at 04:34 PM.

     
    Old 06-17-2005, 05:06 PM   #8
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    Re: Does anyone see a pain management Dr.

    Hey wilson!

    Thank you for your kind compliments. I'm only as knowlegdable as the "tools" I use, or subscribe to. I try to learn and educate myself as much as possible about what ever my condition is, which are a few besides the FM.

    I THOUGHT I have seen your name on the PM board!

    You seem to have quite a good grasp on your situation. I would keep plugging along on the path you are going.

    I consider myself lucky to have a great PM doc. Matter of fact today I got a call from and MRI facility calling to set up an MRI on my brain and lower lumbar that my PM doc had ordered. Bless his busy soul. During my last visit, I saw his PA (they rotate appts monthly with us) and I mentioned that I had both MRI's scheduled and I would be bringing him the results cuz I didn't want anyone else seeing them before he looked at them. So our signals got crossed somewhere. He does that though. You'll mention something to him in passing, and about two weeks later you've got a call from a Compound Pharmacy, an MRI faciltiy, or something like that. I think he's a couple weeks behind his charting! But he really does care about his patients. He has already told me that if I had back surgery and it was sucessful that he would continue to treat my FM pain as long as I needed him. Of course I just had a "ninny of a Neurologist" tell me that he didn't believe surgery would help me, so I can't get passed him to see a NS. UGH. But I'm betting my PM doc can get me to a NS. He doesn't have "chain of command"! I love an aggressive man! LOL

    Nice to hear from you again. Like I said, sounds like you are going the right way. Keep us posted. And I am all about that Zero Gravity chair. Where do I get one?

    Hugs,
    tk
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    Old 06-19-2005, 06:22 AM   #9
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    Re: Does anyone see a pain management Dr.

    I see a pm and rheumy. My initial flare was both fms and cmp and it was hell. I don't know what I would have done w/o my pm doctor and her physical therapist. I had trigger point injections and myofascial release for 8 weeks and now see a chiropractor as needed for myofascial release. I was on percocet for pain until a week ago. I take neurontin 150mg qid for burning skin sensation and am also off of tramadol. I take flexeril to sleep. Hope that you feel better soon. This time last year I was bed ridden.

     
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