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    Old 07-07-2004, 07:39 AM   #1
    Kayley
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    Question My pm doctor wants me to see a psychiatrist

    Hello
    I was at my pain management doctor's office yesterday and I told him I don't want surgery and my reasons behind it. If you're not familiar with it, it's because the surgeon told me although it is possible, but cannot be guaranteed, that he can fix my pain that travels across my chest (caused by a herniation at t-6 and t-7), he does not believe my back pain can be fixed. My back pain is just as miserable as the pain that travels. He understood my reasons and he was very nice. I then brought up the subject of getting used to living in pain, and the fact that I'm trying to accept that my life could always be this way. I told him that people are constantly telling me how well I'm adjusting. He then told me he thought it would be a good idea if I see a psychiatrist. He told me most of his patients are clinically depressed. I really do think I'm doing pretty well mentally, although there are times I get depressed, and mostly I get angry at my family for not understanding. I try to tell myself they cannot possibly understand, but I still get angry when they don't. Like for example, when my mom was in town and the whole family and some friends went for a pontoon boat ride. I didn't feel up to it, and she started crying. I felt guilty for not going, so I started crying. Things like that really get to me because I want so bad to do things, but I know if I do them, I'm going to pay for days afterward.

    I think I remember someone here saying that there are special psychiatrists who specialize in chronic pain. Of course, I don't know if my insurance has any on their list, but I could check into it. Has anyone been to a psychiatrist for issues dealing with their pain? The doctor said he was going to send a letter to my primary doctor recommending that I see one and I am trying to decide if I want to go that route.
    Kayley

     
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    Old 07-07-2004, 08:44 AM   #2
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    Re: My pm doctor wants me to see a psychiatrist

    Hey Kayley, Every PM group I have ever seen at least had a Psychologist on board. My PM doc is a Borad certified Psychiatrist and Neurologist that is part of a large PM practice with docs with other specialties, Anesthesiolgy, physical medicine, Osteopathic med. He doesn't have time to do the 45 minutes on the couch with each patient once a month or once a week so they refer folks to their in house psychologist or if your more comfy with a seperate doc, apart from your PM group it gives you a little more privacy.

    The PM doc prescribes enough meds each month to truly harm yourself, statistically CP patients are 700x more likely to commit suicide than the average person, whatever average is. So true concern is par for the course. I've taken that dang MMPI 3 times since being involved in PM. Someone's psychological condition should be part of the treatment plan. If your at high risk then certain meds should be used and some meds shouldn't.

    Although depression is par for the course consdidering all aspects, It doesn't mean you have a chemical imbalance that needs tweaking. From what you described in your short post, You do have some issues regarding guilt, anger and depression. Just having smeone to talk to can help. I'm sure you get tired of apologizing for what you can't do. I know CP patients spend to many worsds each day, explaing and apologizing for what we can no longer do or how we have changed.

    Seeing a psychologst is just a mental health check up to ensure you won't harm yourself with the meds given by the PM doc. You do not have to take any med that a psychologist wants to rescribe. Yes we can reach a point where the depression is overwhelming and meds may help, They also think antiD's help with Pain, But you don't have to Take any med that you are not comfy with or talk about any aspect of your life your not comfy with.

    Sometimes it's nice to have a third party say what you feel is normal, we don't need to change your brain chemistry because a pill won't enable you to retrieve parts of your formal life that you are now unable to participate in.

    I understand about the back pain and nerve pain issue, I would say the same thing, Back surgery to relieve back pain has very poor results, However if you have an obvious Impingement of a nerve , and nerve pain is so much harder to manage, It may be something you would reconsider down the road.

    If the meds relieve your back pain but don't touch the nerve pain, surgery may be the option when your ready. Nerve pain does respond to opiates, just not as well, It takes higher doses and usually involves more adjunctive meds that have no garentee of actually helping, I would imagine that if you have nerve pain your probably already taking an antiD , an anti seizure med and posibly more meds than you would require if back pain was the only problem.

    Although we don't know every side effect or long term effect from these other meds, the less the better.IMO

    Dry mouth is caused by so many meds and no where in clinical trials or the prescribing info do they look at the devestating effect dry mouth has on your teeth. I had an 8 K bridge done 3 years ago that needs to be taken out from dry mouth carries and relplaced with a denture, It looks great but the caveties under the bridge work are beginning to damage bone.

    I brush & floss extensively, but the meds aren't going to stop drying your mouth, receeding your gum lines and causing cavities at the margns of your gums and teeth.

    The less meds the better so if surgery can releieve the nerve pain and reduce the med intake, It may be something to consider down the road.

    Anywaym, being asked to consult with a psych profesional doesn't mean he thinks your nuts, or thinks you need help. It's a check up and after the first apt, the rest is up tp you. So I wouldn't fight it, unless it's going to put a huge financial strain which just makes you feel worse.

    Your PM doc should know who specializes in CP as far as a proper referrel.
    Take care, Your not chemically imbalanced or nuts for feeling guilty you can not participate in every activity. that's pretty darn normal to bother someone. If It didn't, then I would be worried.
    Dave

     
    Old 07-07-2004, 12:36 PM   #3
    Kayley
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    Re: My pm doctor wants me to see a psychiatrist

    Thank you so much for responding to my post, Dave. I really appreciate your input. As far as anti-depressant and nerve meds for the pain go, I have tried Neurontin and Nortriptlyne(sp?), and others I can't remember the names of, and they did not help, and right now I'm only on Methadone, Dilaudid, and Dextromethorphan. I have been on anti-depressants in the past, but gave them up because of side effects. I know there are many others I could try though.

    In my case, the meds do help the nerve pain as well as the back pain. I know that is not always the case, but for me the Methadone combined with Dex has been great. As long as I am comfortable at rest, I don't want an increase. I know it is unrealistic to hope the meds will give back a normal active life. We also talked about the pump at my visit, and the doctor said as long as I am tolerating the meds, without too many side effects, there is no need to consider the pump yet.

    I am going to call my insurance company. They have a separate number for mental health to refer people. My pm doctor doesn't deal with that, he is an Anesthesiologist. I think it is worth checking into. As you said, they cannot make you keep going if it's not helping. And I may need to try different doctors till I get one that is right for me.

    Thanks again for your helpful advice, Dave. Take care of yourself!
    Hugs,
    Kayley

     
    Old 07-08-2004, 10:43 AM   #4
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    Re: My pm doctor wants me to see a psychiatrist

    Hello Kayley, my dear, dear friend!

    I'm so sorry I haven't been posting much lately but please know that I think of you and worry about you constantly.

    I so understand what you're going thru. It's such a shame that we not only have to have the courage to cope with unrelenting pain on a daily basis, but to have to try and deal with the depression, guilt and anger really causes our strength and faith to understandably falter. Some days I do better than others. And I try my best to accept that and my limitations. It's much more difficult for others to accept and even acknowledge the fact that we do have physical limitations that prevent us from participating in some of the fun activities that they so take for granted. I really have stopped trying to explain it or make apologies for it. I guess I'm rather fortunate in that the people I love and care for the most are finally accepting me the way I am today - not how I used to be. But everyday, I can't help but remember how active and "alive" I use to be and then that's when the depression, anger and guilt starts rearing its ugly head. And then I have to just block those memories out as best I can. I often think that maybe talking to a professional would benefit me. But I'm such a private person and the thought of spilling my guts to a stranger is terrifying to me. And I know that any "therapy" professional would not want to just deal with my issues regarding chronic pain, but would also want to dredge up traumas (tragic and many) of the past which I have no desire to revisit. I guess it's just a real individual and personal choice to make. If I could be assured that the topic would remain with problems concerning the chronic pain only then I would be much more receptive to it. I already take antidepressants for the chronic pain and have for years. I know that my problems aren't a result of a "chemical imbalance" or bi-polar disorders or manic-depression so why subject myself to the scrutiny of airing the problems I already know relate to post traumatic stress disorder and just plain chronic pain. I know that there are many people who would disagree with me. Sure, therapy is beneficial for so many people but I'm just not one of them. I know my limitations, I know the reasons for them and over the years I've developed the coping mechanisms that work best for me. People that can't understand them have no business in my life. Plain and simple. Gee, sorry didn't mean to get on my soap-box here. Again, I just think it's a real personal decision as to whether someone wants to subject themselves to mental therapy for physical pain. Kayley, if you feel that it could help you in the tiniest bit I say go for it. You have a particularly complicated situation in that surgery can be an option but the risks are so great. Thoracic disc surgery is just not widely done (I went thru this years ago) as you've already discovered by having to travel to Phoenix to find a surgeon who would do it! I still feel with my whole heart that you made the right decision for now in not agreeing to the surgery. I think you need to be kinder to yourself and accept the fact that as long as the medicine works for your pain, then that's not a bad deal. And you need to surround yourself with people who understand and accept you as you are. Those that don't, don't deserve your love, attention or time. I feel honored to know you as I do now and would consider it a privilege to be part of your life as it is. You've had a tough row to hoe and I think you are alot stronger than you give yourself credit for. To realize that we will be at the mercy of PM for the rest of our lives, whether it's with meds, pumps or whatever is not the most joyous of thoughts but it's better than the alternative.

    Gosh, I'm so sorry I starting rambling so much but, Kayley, I feel I do know you a little bit and I think if there is some small voice telling you that maybe talking to a professional will help you in any little way, then try it; especially since you don't have alot of support and understanding from those close to you. I do so I'm just thankful for that. One thing you mentioned that I can relate to so much is that when you try to do something "fun" or enjoyable, you end up paying for it big-time. Boy, I know what you mean. But my thought is that this ole life isn't a "dress rehearsal" and if I want to do something that will bring a smile to my face for just a moment, then by george, I'm gonna do it and accept the consequences that follow. It's taken me a long time to get to this point, but I just feel like I have to keep trying to find a reason to laugh each day. And if that means pushing myself to the point of more pain, so be it. I hurt like heck anyway and I think we deserve to do what makes us happy for a time. The next day or whatever, I take my meds and take it easy. And I don't regret the effort. The payoff is worth it to me!

    Take care my friend and know that I'm here for you. Your pal, Linda

    Last edited by lindao1; 07-08-2004 at 11:01 AM.

     
    Old 07-09-2004, 10:34 AM   #5
    Kayley
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    Re: My pm doctor wants me to see a psychiatrist

    Hi Linda!
    Thank you so much for talking to me, you are such a good friend! I agree with you that this life is better than the alternative, for sure!!! I do have something very joyful in my life right now. I don't know if you heard, but my daughter had her baby girl last Saturday. She is staying here with us during the day and I'm really enjoying it. Her name is Amelia Elizabeth and she weighed 7 pounds, 7 ounces and was 20 and a half inches long. She is so beautiful!!! It's going to be hard when my daughter goes back to work and I can't see her as much. I would love to babysit her during the day but there's just no way I can in my condition. So I am just enjoying the time I have with the little angel

    How is your hubby feeling? I hope he's feeling better. I agree with you that some things are worth doing, even if we have to pay the next day. Like getting to see my grandbaby born, that was definately worth it! Thank you for being here for me, it means alot to me.

    I hope you all have a fantastic weekend!
    Hugs,
    Kayley

     
    Old 07-09-2004, 12:00 PM   #6
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    Re: My pm doctor wants me to see a psychiatrist

    Congratulations Kayley!

    YIPPEE! YIPPEE! I didn't know your daughter had her baby - and a week before my sister's birthday - how cool is that! I am so happy for you and I know that at least right now, you're on cloud nine so enjoy every moment. Amelia Elizabeth is a beautiful name for a beautiful little girl! My, my 7 lbs, 7oz! She sure came into this world healthy, thank God. I know you would love to babysit this precious one but you must also realize your limitations and don't apologize for them! I'm sure you'll have many, many years to enjoy the company of your little angel. Do what you can and just accept the rest. After all, Amelia wouldn't want her grandma to overdo things too much and then feel real bad for too long. She's gonna bring you so many moments of joy so just savor everyone. I wish so much that I could see a picture of her! Darn! Darn! Darn! Anyway, I'm so happy for you and your daughter and please let your daughter know that I send my best to her and hope she is doing well.

    "Grandma Kayley", you take good care of yourself and enjoy all the great moments that you have before you. You will have many more to look forward to! And stop apologizing for the things you can't do. Heck, we've moved enough mountains in life already. I think we deserve a break! Hee! Much Love, Linda

    PS. Thanks so much for asking about my hubbie. He's had two epidurals and the last one seemed to help quite a bit. He still has the disc problem at L4 but he will not have surgery until there's no other option and his PM guy is agreeing to treat him as long as possible so he can hold off of any surgery. In fact, he's doing so well he's going back to full duty from light duty. He's really happy about that and so am I. It's great to see at least one of us doing better - ha! Again, thanks for asking!

     
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