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After Multiple Kidney Stone Attacks, Doc Says Pain Management Clinic Time??

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Old 09-28-2004, 03:55 PM   #1
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Unhappy After Multiple Kidney Stone Attacks, Doc Says Pain Management Clinic Time??

Since February, I have passed many kidney stones and am now starting to get bladder infections. I have been to a urologist who basically said the only stones he saw on my tests couldn't be causing the pain I describe because they weren't the type that usually moved/passed. A week later, I was in the ER passing a stone and also had a bladder infection. The whole time though the pain in my back has been getting worse and worse and I have been on a lot of pain medication. My family care doc now wants to refer me to a pain management center because my latest urine test looks fine, but I am still having pain. I just kind of got the feeling from the nurse that called me that because the test didn't show anything they are passing me off to a pain clinic to basically give me pain meds. I just feel at this point they don't believe me, yet I keep ending up in the ER with stones that show up on the ER scans. I feel somewhat offended, almost like they think I just want pain medication. What exactly is the reason for pain management center/clinics?

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Old 09-29-2004, 03:02 AM   #2
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Re: After Multiple Kidney Stone Attacks, Doc Says Pain Management Clinic Time??

Is it just me...or does anyone else feel the medical professions has changed drastically in the past 5-10 years? I am finding it so difficult to find a Dr. who truly "listens" to the patient. I consider myself fortunate to have two dr's who do listen to me and are compasionate, however, I have consulted with two surgeons who appear a bit arrogant and like this poster's experience - the 'test' determine that my other symptoms couldnt be related to my hernia - period, end of subject.

Why does it always come down to what the "tests" determine instead of dr's considering the patients explanation of symptoms too? Is it me or are others experiencing the same treatment in the medical community?

I would advise you to consult another urologist and/or ask your current dr about Interstitial Cystitis. A pain clinic is when every treatment has been tried and hasnt worked. If your dr. is suggesting the pm clinic, it appears he is taking your pain seriously and believes you - if this is any comfort

Old 09-30-2004, 09:35 AM   #3
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Re: After Multiple Kidney Stone Attacks, Doc Says Pain Management Clinic Time??

Hi Jule, Stones can be extremely painful from 1mm gravel on up to a staghorn stone. After passing about 30 stones and having cystoscopic surgery a half dozen times I was referred to a Nephrologist. "A kidney doctor" We did blood work, a couple 24 hour urine catches and determined why I was creating srtones.

Mine were calcium oxylate, you could also have "mind went blank on the other type" and then you have staghorn stones that basically can fill the entire ventricles of the kidney and require open kidney surgery to remove. They are called staghorn because they look like a deers antlers once having filled the major ventricles of the kidney.

As far as your stones not being severe enough to cause the pain your complaining of, there is no way for a doc to make that statement. a 1mm stone doesn't cause a pain score of 3, a 2mm stone doesn't cause a 4, a 4 mm doesn't cause a 5.

Pain is completely subjective. There are still docs out there telling people MS doesn't cause pain. Ask an MS patient if they have pain?.

To me it sounds more like he's passing the buck. If you have gravel in your kidneys, they can't be brken up much more by lithotripsy and they can be extremely painful. A friend of mine had terible pain from a tiny clot in his kidney that had been slowly growing from an injury palying basketball. The clot was only a couple MM large but in the right place, blocking the right area from receiving blood flow, The tiny clot doubled him over in pain.

I wouldn't interpret being referred to PM as believing in your pain. He could continue treating you if it wasn't less profitable than surgically removing them. It sounds like he's opiate phobic, concerned about addiction and wants someone else to deal with you.

I would go back to my GP ask to see a kidney specialist, not a urologist ,a Nephrologist. Find out what is going on that is causing the stones and find the right medication to stop the stones or change your diet to stop the stones. Urology for stones is simply pain management or removal if the stones obstruct the kidney.

Seeking a cure or a a reason for the formation of these stones would be more of a diagnostic process that urologist don't make money on.

JMO but you don't know if the PM he's referring you to will teach you self hypnosis, biofeedback, relaxation techniques or actually use pain meds. If you go weeks between passing gravel of painful flares, you don't need to be on LA morphine every day. Simply managing the flair or particular passage of the stone is something any urologist is capable of doing but once it's been a year and he looks at a stack of C-2 prescriptions, They start to get hinky about treating the pain and make absurd comments that a stone that size or that type can't cause that much pain.

He's saying it's in your head so I wouldn't expect to see a PM doc that deals with folks with disabling pain that prevents them from having any quality of life. You don't even know why your producing stones so there is no chance of finding a cure for stones from a PM doc. Diagnostics are not the PM docs specialty. They manage pain once there are no alternatives. What prevetative treatment has he offered? That's why you need to see a nephrologist.

I haven't passed a stone in a couple years now since taking the meds to treat the calcium absorption problem that I had. But my GP was getting tired of treating the pain, the Urologist was getting tired of simply treating the pain and plucking out small stones that obstruct the uretor, so he refered me to a doc that specializes in kidney function and what causes changes in kidney function. Nephrologists do more than manage dialysis. They can do the diagnostics, find the cause and develop a preventative treatment plan. I doubt your going to find a PM doc that will do the tests required to come up with a solution other than managing painful flaires.

My main question is wht type of stones do you have, have you researched these type and what have you found as far as treatment or preventatives. Look for a cure, not a mask with opiates and relaxing definitely isn't going to prevent stones.
Good luck, Dave
By the way, Tyler has been through the same and may have some advice too. There is nothing wrong with treating the pain, but a I'll take a cure anyday if it's something as simple as taking Potasium citrate "slow K" and HCTZ will prevent them. Obviously you need to drink as much water as possible but there are cures for chronic kidney stones because there is usually a reason you produce them.It's only a mystery if you don't look.

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