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Torley 06-06-2005 08:33 PM

Re: Dave can you share your wisdom with me
 
Hi dave
drugs are supplied subsidised through the below link. fully subdised one sI pay nothing for but things like neurontin are pricey ets and synthetic morphine
http://www.pharmac.govt.nz/

pharmac have free medicines eg morphine and methadone are free

My Relationship is falling apart he thinks I should suck it up more, and our sex life has almost been non existant due to the meds, which I have tried to get changed and help for 5 years. Every time I have been to the doctor I have asked for hlep etc with my list and nothing. so its lead me in a terrible predicamant.
I was treated pretty badly in hospital, eg delays in giving meds etc eg 1/12 hours and no one certified to adminsite rmy pca and so 2 hour waits, it was bad . I was beside myslef plus they had locke dmy meds up for security reasons hmmmmm yeh right. so I had no control to help. Our hospitals are all state funded so I have no choice where I go. its like it or lump it

I see the Head Pain guy on Thursday, he will review meds I am on he may even run a trial of neurontin, I will also ask what was the results of tests and why were they blinded, why did I get rarcke dup by the doc and he said I left voluntarily all i wanted was pain relief, He also told me he would abort future pain treatment and why did he lie about me levaing voluntairly when I went out of Emeregncy fell over twice again on my head and then called the duty manager to complain. My mum complained earlier that day re his ethics and procedures so I think that is why he excerbrated it and had more of a go at me I think he wanted to get me out of there so there was no evidence.
All I asked for was pain relief, he started on this blame thing and defensive thing, I sai dno I just want help my pain is at a 9. I think he realise dhe stuffed up as he is foreign and may have been using me as a guinea pig, My mum got the code of patients rights and read it and he breaches about 3 clauses.

Brain fog, constipation, pain, depression are some of my ongoing problems I want to discuss as well as all th eprocedures and results.
Thanks for not giving up on me, words cant express my gratitude.

will talk more later

thanks

debs

Torley 06-16-2005 07:18 PM

Re: Dave can you share your wisdom with me
 
Hi Dave

I saw my head of pain dept last week.
he has taken me off voltarene as he thinks I have bleeding from my stomach and problems with back up at the top of my bowel which they saw in an xray in hopital. I have no idea what that all means except that I have waste that may have been sitting there awhil as I swing between constipation and diarrhea.

So I will make an appt to see a gastro.

he has referred me to see a psychaitrist to look at the antidepressants I am on.
I am also still takign large doses of painm meds for my head, eg maybe spinal maybe concussionm.
He put me on neurontin and I had an allergic reaction to it, then tghey gave me phenrnergan and thatw as worse then th eallergic reaction I had to take 170 mg seevreol in an hour and couldnt open my eyes fo r2 days, i have since tried the neurontin again and I seem to be tolerating it now.

he will reviw my case, in th enext week or so.
I also got back my notes and have read what the other suspect pain doc had said and lots were omitted eg no adverse effects hmmmm. The comment he had put in was neurpathic somatci pain. What does somatci pain mean?

The last test he had planned was an intercostal block, I am not sure what that is and why ?

Your thoughts?

cheers

debs

Shoreline 06-21-2005 12:30 PM

Re: Dave can you share your wisdom with me
 
Hey Debs,
It's easier to simply copy from a medical dictionary about the 3 types of pain, I would end up with a book of examples.LOL ;)

Types of Pain

There are three types of pain, based on where in the body the pain is felt: somatic, visceral, and neuropathic. Pain of all three types can be either acute or chronic. Somatic, visceral, and neuropathic pain can all be felt at the same time or singly and at different times. Most cancer patients experience both somatic and visceral pain. Only about 15-20% of all cancer patients report neuropathic pain. The different types of pain respond differently to the various pain management therapies. Somatic and visceral pain are both easier to manage than neuropathic pain.

Somatic Pain
Somatic pain is caused by the activation of pain receptors in either the cutaneous (body surface) or deep tissues (musculoskeletal tissues). When it occurs in the musculoskeletal tissues, it is called deep somatic pain. Common causes of somatic cancer pain include metastasis in the bone (an example of deep somatic pain) and postsurgical pain from a surgical incision (an example of surface pain). Deep somatic pain is usually described as dull or aching but localized. Surface somatic pain is usually sharper and may have a burning or pricking quality.

Visceral Pain
"Viscera" refers to the internal areas of the body that are enclosed within a cavity. Visceral pain is caused by activation of pain receptors resulting from infiltration, compression, extension, or stretching of the thoracic (chest), abdominal, or pelvic viscera. Common causes of visceral pain include pancreatic cancer and metastases in the abdomen. Visceral pain is not well localized and is usually described as pressure-like, deep squeezing.

Neuropathic Pain
Neuropathic pain is caused by injury to the nervous system either as a result of a tumor compressing nerves or the spinal cord, or cancer actually infiltrating the nerves or spinal cord. It also results from chemical damage to the nervous system that may be caused by cancer treatment (chemotherapy, radiation, surgery). This type of pain is severe and usually described as burning or tingling. Tumors that lie close to neural structures are believed to cause the most severe pain that cancer patients feel.


Costovertebral nerve block
A block that is performed under fluoroscopy to identify the costovertebral joint as the pain generator and decease or relieve pain in that area and out toward the lateral rib cage.

Intercostal nerve block- An intercostal nerve block is an injection of a local anesthetic in the area between two ribs. An intercostal nerve block is performed for pain due to herpes zoster (commonly known as shingles), an acute viral infection that causes inflammation of the nerves that spread outward from the spine. It may also be performed for pain caused from surgical incision in the chest area or to help determine the cause of your pain. (diagnostic nerve block)

He would likely do a block for diagnostic purposes, if it worked, the next step would be either some type of nerve destrution, "Chemical or Radio Frequency Ablation" or perhaps a spinal cord stim trial. The newer SCS have multiple leads with multiple settings, much more advanced than the old sstem, but tey need to find which nerves to buzz or destroy. Did you bleed excessively or require a chest tube during your surgery. A chest tube can cause damage to the innyercostal nerves. Also has anyone sugested you might have RSD or CRPS "chronic reginonal pain syndrome" This usally occurs from poorly treated pain or mis diagnosed problems. Is the area discolored, overly sensetive to hot or cold, to the slighest touch?

Because nerve damage doesn't just happen. Complications from surgery, instruments or gauze left behind, chest tubes, infection can cause these problems. Did you Code during surgery "Heart stop" and require chest compression that might have broken or damged ribs and suroundng nerves?
The mystery gets deeper.

Take care and stay in touch, Dave

Shoreline 06-21-2005 01:02 PM

Re: Dave can you share your wisdom with me
 
I'm sorry t hear about your relationship having problems. Unfortunately tht's par for the sourse. People get sick or injured and have surgery and medical rtreatment, and our friends and lovedones expect us to get better, most of the time this happens. But when things don't get better or get worse, for sme reason resentment is the best emotion I can think of comes to play. They aOrur spouses or SI's our sympethetic, empethetic up to a point and then they believe we should have gotten better by now or that it's something we can suck up. Unfortunately that isn't always the case. Can yo imagne Christopher Reeves wife telling hm to suck it up and walk . But with his injury, Broken neck she was told from the get go, he wold not recover, he would never walk again, he would likely need t a vebetalator to breath forever. He did proove themmwrong about the Vent, but Her expectations were based on what she was told by the docs after surgery. For the most part our spouses are told surgery went well, shewe should be home soon and have some modeerate pain while recoverying and be back to our old self. When this doesn't hjappen, They start to get resentful and we start to feel guilty for not getting better. Neither is a rational position, but it's a tough thing to deal with. I wouldn't give up hope yet, Some folks have great success from the SCS and from neuroablation, But there are no gaurentees. I do wish you the best and hope they find something to improve things. The psych may be able to help with he relationship problems along with finding the right med. Antidepressants are notorious for negative sexual side effects. Too bad it doesn't work the other way. At least they would be happy. LOL
Take care, Dave

PS. Check out the post about Pump or SCS, I gave the links to the manufacturer of two new SCS units far superior to the old ones.

Torley 06-21-2005 08:51 PM

Re: Dave can you share your wisdom with me
 
Ahh Dave you know so much, are you medically trained as well?

Well yes the next test that the old pain nasty man was going to do was an intercostal blcok so I have emailed the hea dof the pain team to see where to from here.
They want to get on top o fmy sever concussion spinal head pain and I seem to be having success with neurontin and clonazepam.Too bad I cant get that subsidised long term as they only give it to epileptics here.

I have also found my old pain doc, and have seen that he works privately so I have a fall back plan, should it all turn to custard. I see he is a trained anesthetist and surgeon, he was the one that rescued me from surgeons who gave me a general to put an NG tube down and I apsixiated into my lungs choked etc was quite serious an dhe stopped the whole procedure and ripped the tube out


My surgerys are as follows

laproscopic cholyscectomy 1999 I came out of this routine procedure screaming in pain which they were very concerned about this was the start of my problems

Then 2 ERCPS where they cut my spincter twice then I couldn tleave the hospital couldnt eat, couldnt lie down couldnt stop vomiting and pain was severe on fentanyl lost a lot of weight and went downhill

Then in May 1999 they did a laparotomy large incision to investigate they had done bone scanes angograms u name it. They also inserted a feedint j tube in my left side under my ribs from which I was fed for months. They also put in an epidural, wronly inserted ., then reinserted I was able after 6 weeks of pain to get on top of my pain and go home

In 2000 they severed all my splanchnic nerves, my pain didnt go away as expected as they thought I had pancretaitis


2002 Another major attack caused by severe cosntip[ation they gave me picoprep and my whole insides went into spasm I was there 7 weeks on fentnyl amd ketamine pain pump and also another epidural was inserted at the end and a feeding tube inserted again same place. After one week I was able to go home due to this
The feeding tube blocked and It was taken out and a new one reinserted.

I have alot of scars on my stomach, all feeding tubes are in same place where I get pain thru to my back, laparomtomy from stomach to navel.

I also had my appendix removed when I was 12

On my notes that I now have , there are few details where this old pain guy did procedures.hmmmmmm He has said tho somatic neuropathic pain and he wa sinterested in my scars.......

I am intending to lay a complaint about how and what he did to me so that others do not suffer like i have.
I said to him when I first started that I was depressed, written in my notes he said no shes not, pain problems and constipation. I now have back up in the top of my bowel which showed on an xray a couple weeks back in the hsopital, th every problems I wa sthere for 7 weeks previously. I am going to see a gastro guy for help as that with narcotics can cause majors and i have been swinging from cosntipation to diarrhea for years, an dI can use up to 9 hsopital grade fleet enemas and still not have completley gone.... gawd the things then we in pain go through. It may take an hour a night fo rme to deal with . darn it

They did say that they believed that my pain had been treated poorly an dhave referred to wind up .... I hate that name....
Thats why they put me on ketamine a few weeks back in the hsopital and for the very first time I was lucid and not spaced out.....I only wish there was soemthing liek the ketamien to take orally etc.

My whole aim was to get off as many of these drugs orally eg a pump so that I didnt have pills for pills and severe constipation. I wont give up and I will also seek


The feeding tube is like a real large whole that sinks inwards like a belly button

Gallbladder fossa was on my notes appeernetly there was a problem and they went in and fixed it at the time of the laparotmomy

I beleive that the ops they did have done and given me this pain. I was fine until then. I am going to try and prove that.


I note below what u say.....I didnt code but the first surgery I was screaming and I have since read that lap choly's are notorious for problems....

Because nerve damage doesn't just happen. Complications from surgery, instruments or gauze left behind, chest tubes, infection can cause these problems. Did you Code during surgery "Heart stop" and require chest compression that might have broken or damged ribs and suroundng nerves?
The mystery gets deeper

They have suggested CPRS and that my pain was not properly treated..

On the antidepressant side I have heard that lexapro may be better on the sexual side, which I am going to read up on.

Yes and thanks for the words above about sucking it up, its a wonder any relationship survives I am hangin in there but I am th emain breadwinner so its hard.

Its also had trying to tel the otehr half that I cant suck it up sometimes,....I mean I do moistly but its hard, I mean it gets old talkign about it to them , I mean where is the light at the end of the rainbow especially when they hav eno idea what they did to me .So its kinda hard to treat.

I must also say that when I am in hospital it is so short staffed and the ward I was in had nooone certified to put in an IV line for my PCA or to administer it ehnce when line came out or they were sposed to give me hourly meds also and I woudl wait 1 1/2 hours later to get them. So you get felt to be bad for ringing a bell or askign for anything. I also cant sit still even in pain I will walk around or sit up in a chaor lying down is painful for me.

Eg when I wa sin with the concussion and psinal headache it set off my old pain .so lying down helped my head but I couldnt lie down as my abdo pain got worse so I was changing positions every 5 minutes. I find it easier just to sit in a a recliner

thanks again really appreciate your interest and input :)

talk to you soon

debs

Torley 07-05-2005 05:09 AM

Re: Dave can you share your wisdom with me
 
I wen to see my pain doc the new one last week
lets say teh contrast between the old one and new one are out of sight. I am still considering formalising a complaint against the foreign doctor who treate dme abhorrently and obtaine dno writtten consent for any of his procedures and effectively used me as his guinea pig. I will do this in part to ensure that noone else has to go throught what I went through and maybe to ensure he doesnt stay in New Zealand.

I have gone back and have had good success with neurontin and I am only on 600 mg a day so I hope that with that increaisng I will be able to drop my morphine.

I have also made it very clear that my intention is to have a SCS or pain pump, but they have onoy done scs for angina pain in anotehr hospital clos eby, and maybe 2 to 3 pain pumps in th ehospital I am at now. I have said that this is my expectation as th epain meds cause me such sever cosntipation that I cnat cope anymore.

I have also gone to have a gastrocpy to see if i had an ulcer, what they have seen is a lot of bile and I am unsure why, I saw this sugreon re the cosntipation and his answer was to remove my large bowel and that would fix it, I sai dno I would rather have the pain treated. He was th eperson who left me in the position int he forst place from the first surgery so there is no way i wil go back to him he also almost kille dme putting an NG tube in via a general but the pain doc anesthtist stopped the procedure.
So cut happy surgeon is off the christmas card list
I am stil lsuffering fromt he svere headaches be they spinal or concussion.
I have also halved my nortryptiline dose and stoped th eimmovane and aropax in the last 2 weeks.

I have also seen the pain psych who saw me 6 years ago when I was in pain and also starte dth evisit off ith saying I had a checkered history with my treatment her goal is to restor emy faith teach relaxation and TM.

I am scheduled to see a psych as well in 2 weeks as well as my pain doc. Not to keen on the psych but hey will talk with her.
Since my complaint re my treatment lets say that I am now gettign some help, for the first time.

Another goal I have is to go back to the guy that caused my inital surgery problems until he admits fault, I have time and insurance and will succeed,

I have doen a lot of research on site sre my pain blind tests and us eof placebos and see that the american pain society find sit abhorrnet, I also have found that here in NZ that they must get written consent for proecures none of which my old pain doc did.

I am no longer angry, but I will complain so that he never does this again and treats people in pain with such constempt and unprofessionally and also doesnt treat their pain, eg no compassion

cheers

debs

Shoreline 07-05-2005 12:12 PM

Re: Dave can you share your wisdom with me
 
Hey Deb, Have you contacted medtronics, the maker of most pumps and most SCS, to see if they have the name of a doc that is certified by medtronics for the implant and maint in NZ. It's a multi billion dollar biz and I can't imagine New Zealand without . Certainly Australia if that's possible.

You really ought to try that recipe for Yakima fruit paste, I'm still amazed by it. You have to find the right dose, but contstipation has always been an issue, even with the pump.

Alot of folks have good successs with neurontin. I've seen folks take as much as 3600 mgs a day. Most can tolerate it up to a point and then have to back down to the previous dose they tolerated, your brain will let you know when you have reached the max dose without feeling dopey. Things like forgetting why you went in the bathroom. LOL

As fa as blind tests, what your doc did was above and beyond and defeats the purpose of ding a plecebo trial. The idea would be to convince a patient they just got a very large dose of a potent med, not be a jerk and loose any possible pych effect by creating such a hostle atmosphere :nono: . So if he was doing a plecebo injection, he blew it with his demeanor. Medtronics actually sugestes they do a placebo trial where the first dose or med is saline but some docs don't like to needlesly do a lumbar puncture to prove a point.

I am glad you seem to be heading down the right road. I've called medtronics several times to ask questions, if you guys don' t have a rep in your country, it may give them incentive to come to NZ, teach a few docs about these devices and help them get started sounds like good international marketing for a US made, but international company.

Dig deeper and find out who is doing them In your country,o the closest point in Aus. someone has to be managing them if they implanted any. Which may leed you further in the right direction.
[COLOR=Red]Go- Deb- GO!!![/COLOR]

Do they use the expression the squeeky wheel gets the grease in NZ. Unfortunately, too many people are told they just have to live with dibilating pain and do so for years, when it's just not true. It's simply one or a couple docs opinion.

I've had at least a dozen PM docs, surgeons and PM psychologist during the first 7 years tell me I just had to learn to live with it and if I used their "method" I would be fine. :rolleyes: I tried it, if part of what they had to offer worked, I would hang on to that and pitch the rest as I moved on.
Take care, Dave

Torley 07-05-2005 01:28 PM

Re: Dave can you share your wisdom with me
 
Hiya Dave

yes they do use the experession the squeaky wheel gets the oil, and thats what I intend to be, for 6 years they didnt help me and in fact my new pain doc said who has reviewed your drugs in the last few years I said noone, I tire dfor 2 yeas to get an appt with u guys he gulped. In fact I am sure my primary doc never requested and appt with them so he is now sacked!!!

A good point re medtronics, I hadnt thought of that, I will get in touch and yes they need to teachotheres here in NZ how to do it, I know Aussie do heaps but not here, I suspect its due to the cost of it. The cist I have heard here for a SCS is 26 K

I have bought some figs and so wil try these and see then the paste, but there no way I will have my bowel removed , lol some surgeons just want to make money I feel.

I am also going to see a GI and a neurologist in the next week or so to discuss options

On the final note, I am visualising what I will do when I see the pain doc who caused me grief, he must be very worried as he knows he stuffe dup. I also know now that I have my notes that he has taken out the tests and drugs that he used and results a bit naughty really. I will when I see him stare him down and I may also rank him to his face at -2 out of 10 and tell him perhaps he needs to remove himself from th epain service. I think if he did that then I may consider not complainign, but I doubt he will due to his ego so I may for satisfaction complain and then he can feel some pain that he has caused people like me

Debs

Torley 07-15-2005 02:12 AM

Re: Dave can you share your wisdom with me
 
well

the new pain doc is onto it. I now have a psyhiatrist and pyshologist appt, I am at physio due to my head injury. I have stoppe dpaxil, immovane and halved the notryptiline. I must say that its hard getting off the paxil it has nasty side effects, dizziness tiredness head spins etc. I wont be taking that again will stick with TCa's

I have now been able to get almost back to my premed state before the epidural block and head injury. I go back to see my pain guy next Monday 25th and I will be askign about the next stage being the intercostal block an increase in neurontin and a pain pump.
I did some research and medtronics have an office in Auckland, I will be pushing fo rhim to learn to do this or someone else as I wont off the oral painmeds.

Havent been to a psych before not sure if I am that keen, saw the psychologist aweek or so back and they are looking at relaxation techniques and TM. She staret doff by saying she needs to build my trust as I have had a pretty raw deal at the hospital.

I havent worked out what I am going to say to the ol dpain doc if I see him. I may just stare him out and tell him he needs to develop some compassion especially if he is workign in pain.

Debs

Shoreline 07-15-2005 09:22 AM

Re: Dave can you share your wisdom with me
 
Hey Deb, That's great Medtronics has a rep in Aukland, That is a pretty good indicator there are docs trained to implant and manage pumps and stims in the area, Did you get to talk to the nmmedtronics rep? I've talked to both corportate HQ and our local rep prior to the pump and since the new synchromed 2 came out.

The aukland rep will know who in your area if anyone is certaified by medtronics. Managing a pump is just as important as implanting it properly. The implant only took an Hour, but adjustments and adunct meds are the time consuming part. Is traveling to Aukland a posibilty,How far is it from where you live? Any friends or family you can stay with while they get you in and start the adjustment process.

Adjusting a pump can take months to fine tune but can certainly be adjusted to manage the worst of the pain in a matter of weeks if you don't have a problem with side effects. With the new pumps you may be ale to go as long as 6 months before needing a refill depending on the concentrationn of morphine per ML and the flow rate. When they switched me from morphine to Dilaudid my refill interval went from 28 days to 85 days. but that's with the old pump that has an 18ml resevoir, the new one has a 40ml resevoir, so my refill interval would be more than doubled with the new version of the pump.

I actually like my shrink. He's my guy to bounce medical questions off of, talk about new policies and treds in manged care and. It's not like he has control over my life or my PM, He's simply my gy that I talk to about whatever I want, It's my dime so I spend that time the way I want. Bio feedback is pretty cool when you can actually see and measure the changes you can make. I could dramatically reduce my level of pain while doing it, but when you have to come back to the real world and deal with kids or family or a job or whatever, it's hard to stay in that completely relaxed state.But it's another tool to have in your bag if your having a flair that you can't manage other ways.

Do be careful discontinuing Paxil, It has a horriable reputation in the states to discontinue. If you have to go super slow, that's what you have to do.I've met folks it took 6 months to DC so don't try to be tough and rush through it. Discontinuing Paxil abruptly can cause serritonin syndrome, land you in the hospital and be life threatening. It's always amazined me how any doc in any specialty will through these psych meds at people and not worry, but when it comes to pain meds they act so foolish. Let a doc try to discontinue Paxill in 10 days and then determine how freely they want to dispense it.

It sounds like things are moving and in the right direction, keep me posted and keep hangin n there.
Cheers, Dave

Torley 07-17-2005 01:39 PM

Re: Dave can you share your wisdom with me
 
Hiya Dave

yes I have discontinued Paxil
I did it over 2 weeks ands have been clear for 10 days now, I am so glad to be rid of it!!! what I did notice is that it was only when I got off that completely that my bowels started to work again. I am also off the sleeping tablets as well I know what you mean about the paxil and prescribing docs. Yeh let them see what it does take to get off it. I know its nasty I had head spins etc, My PM doc said give it a try he actually convinced me I was no longer depressed which he was right and didint want to give me anotehr one even tho he has now given me a referral to s shrink . lol.

I didnt know about that serotonin syndrome and will read up on it.
I havent talke dot the medtronic rep but its a good idea. i am fairly sure my first PM doc is doing th eimplants in my local hospital so I will check the ones that are only done in Auckland are the SCS so I will chekc out who is qualified and lol even suggets to my current PM doc he does this. He I have found out was top of his clas sin Australasia, which doesnt surprise me hes like the professor out of back to thte furture in a a nice way :)
Ha I will probablu tell the shrink that the old PM doc needs to learn compasison and rethink his career maybe even go back to Sweden lol. I may not hold back on him hahah.
Yeh I am feeling a lot better and will go back to work part time next week.

The pumps out of curiosity cost 26k here, what do they cost there> They only do them when all else fails and I think you need to push hard which is what I will do.It seems that the best pain killer on me is ketamine and well it cant eb taken orally so it may be my in.

I am also going to see a gastro guy next week to see what he has to say as well, and am going to go back to the neurologist I saw a few weeks back. Tell me are they better suited to understanding nerves then PM docs? tehy are better trained are they not?

Thanks


debs

Shoreline 07-17-2005 10:29 PM

Re: Dave can you share your wisdom with me
 
Hey Deb, I hate to generalize about any specifc group of docs. Some PM docs are very good neuologist and some neurologist don't consider themselfs PM docs. It just depends on where they want to fucus their pactice. The head guy at m clinic is a nerologist/ZPsychiatrist, but the anesthesiologist and physiatrist/genberal surgeon do the pump and most of the interventional procedures "Needle work"

In the staes, it seems most neuro aren't pain mnaagemnt doc or don't shoose to use opiates. Now if your talking Neurosurgeon, then I would take a neurosurgeon over an ortho surgeon for a spine problem. But it just depends on the PM docs area of specialty, any doc can reall y practice PM when all you ned is a script pad. There is actually no such major or residency program for Pain management. It' s mnore of a combination specialty of neurology, physical medicine, anesthesiology and if you have spcifc pain you may find PM that are GYN's, Reumeys, Nephrology or Urology for conditions like ICS.

Universities have a very poitical atmosphere, and In orderr to create a true pain management program, all those other programs would have to accept students into particular classes or give up funding to create a program that teaches a little bit from every medical dept I m,entioned. Obviously the anesthesiololgy resedent is going to get first crack at true anesthesia residencies before a hospital excepts a student for 6 months advanced training in each specialty.

It's basically like bringing a new sport to a school, It's either going to take funding away from all the other programs which makes those program directors mad or they have to find more funding to create a new team sport.

Pain management would entail aspects of all these different specialties, "Neurology, Physical medicine and rehabilitation, Anesthesology, Psychiatry,Rheumatology, Osteopathic medecine-DO's, even chiropractic should be part of a pain management education or residency. Since there is no specfic training available for pain magement, docs from other related fields steer towards existing Pain managemnt facilities in University hospitals. Doing a clinical residency at a hospitals pain clinic is about as close as we have to a Board certification or a fellowship program in Pain management.

AS it stands, there is no such thing as a Board certified pain management doc. If any GP is willing to treat pain, he can hang a pain management sign over his door. In that sense, a neuologist would have more eduction or experience in your nervous system and brain activity than many PM docs without a Neurology background. But that doesn't mean the neurologist will be willing to manage long term, chronic pain or call himself a PM doc.

I hope I didn't over explain the whole PM doctor thing and do hope you get a chance to do a Pump trial, perhaps that's the purpose of the shrink referral, to do the psych eval for a pump.

Take care, Dave

zandy 07-18-2005 02:12 AM

Re: Dave can you share your wisdom with me
 
Shoreline,

I believe you may be wrong on the "board certified" thing...If I remember correctly, my painmanagement doc IS "board certified". But I will check his wall on my next visit (8/11) and confirm. Will let you know for sure then.

He is a psychiatrist with a degree in neurology (and maybe more, again, will check his certificates on his wall more closely and let you know).

Shoreline 07-18-2005 05:22 AM

Re: Dave can you share your wisdom with me
 
Hey Zandy, I apreciate you keeping me on my toes and my reseach fresh
I was just digging around to see if info I learned 5- 15 years ago is still valid. It actually seems even more convoluted now that the established specialties are offering board certification for members of that particlular specialty, whether it's anesthesiology, Physical medecine,Neurology or Do's. Each has now developed or is developing their own board certification process to obtain this title. However there is no one governing body for pain management certification.

There is no such thing as a pain manologists, It's a sub specialty practiced by many different fields of medicine each with their own guidelines and Accreditation procedure and some without accreditation procedures but equally qualified to manage specific problems.

If your an anesthesologist, you could meet the anesthesiology requirments for the sub specialty of pain management set out by the ABA, [I]American board of ansthesiology[/I]. If your a Physiatrist, you would meet the physical medicine boards qualifications for Certification in the field of pain management, and so on. So things have changed over the last 15 years but there is still no one absolute Governing board for pain management.

If you are not already an anesthesiologist, you wouldn't be able to obtain board cerifcication by the ABA, You would seek certification by your own specialty board. No other specialty or sub specialty operates this way.

The demand for pain management and the expected credentials to go along with that practice are slowly being developed, but there is no standard used accross the board, since the area of specialty may be so different from one another. What a anesthesiologist learns and then follows the ABA guidelines for accreditation in the sub specialty of pain management is very different from what a Physiatrist learns during their education and internship in physical medicine and then there standard for accreditation in the sub specialty of pain management. The board of physical medicine and rahabilitaion standards for certification are very different than the America Board of anesthesiologists.

They obviously have completely different backgrounds which can/does leave one specialty cliaming to be the best or the most educated or better trained in this field.

Thanks for making me check myself, things do change over the years, but it seems even more confusing now when you have several, up to a half dozen specialties, offering acredidation in the sub specialty of pain mangement in their particluar field. Whether it's Anesthesiology, physical medicine , DO's or neurology. It's starting to look like pro boxing with so many different heavy wight titles and belts, you can never tell who the real champ is at any time.

I've talked to many PM docs, and there is a higher archy in specialtes. Anesthesiologis for example, came out with the first accreditation process in the sub field of pain management. They have the most drug training and interventional training so should we believe an Anesthesiologist that is cetrtified by the ABA has a better PM program, had greater requirements and higher standards for accreditation Than a Physical medicine doc certified in pain management than those set out by the Board of physical medcine or neurology or osteopathic medicine.

You are corect, they do have accreditation programs for pain management, however each program is designed to take a doc with foundations from their original specialty into the sub specialty of pain management.Which no othr field does. It' sounds more lke flying by the seat of your pants making up Accreditation as yo go, with each claiming to be the new world champ.LOL

This article explains things a little better than I.
[B]Pain Medicine Untangling the Web of Certification [/B]
http://www.asahq.org/Newsletters/2000/11_00/still.htm

There are also pain management associations that anyone can join for the anual fee like the AAPM or the or the APS, but they have nothing to do with accreditation and are not a governing certification body for pain management docs observed by every specialty. Please do discuss this with your doc, I'm sure it will be very enlightening as to the politics of achademia and what it would take to create an entirely new specialty that draws from a half a dozen other specialties if not more.

It's the same with the title Pain interventionalist, There are plenty that make that claim because they can do one or two interventional procedures like epidurals or Nerve blocks, but when it comes to my spine, nobody but a Neurosurgeon or an anesthesiologist who has done thousands of these procedures throughout the course of regular practice in anesthesiology is coming anywhere near my spine with a needle.

Each specialist brings something unique to their PM practice, whether it's Neurology, Psychiatry, Physical medicine, Anesthesiology or DO's. It's just up to us to match our condition to the specialty that would best serve us in the pain management field.

It's a mess that still needs work with at least a half dozen different ideas of what makes up a good PM doc and still no single Body that all PM docs can turn to and say I followed every step and standard of practice set forth by this reckognized certified body that issues accreditation to all docs practicing PM. That would blow the higher archey of those feeling more qualified, experinced and better trained. Howveer that doesn't make any particlaulr specialty the absolute for allpatients. If you need a needle i your spine, find an anesthesiologist, If the problem is headaches you best bet maybe a neuologiust, If your problem is arthritis, I don'thesologist hwill have the answers that a Rheumy would have, If the problem is ICS an internal medicine or gyn may be a better choice. This still leaves the patient going from one "Board certified" PM doc to the next untill they find one that specializes in the problem you need help with.

Thanks for making me stay on top of the mess it still is. ;)

Take care, Dave

Torley 07-18-2005 01:38 PM

Re: Dave can you share your wisdom with me
 
Dave

Thanks for the explanation

Here in NZ the only PM docs are anesthtists, and I dont think theres any certification hence why the swedish guy had a field day on me with his blind tests.
I agree with you , I wouldnt let an anesthtist near me who I dont trust for needlework and prolly now only the head of the dept after th espinal headace from hell

The guy I am going to see also is a neurologist, I think he may also do blocks etc, he seemd to laugh as he has seen many stuff ups from anesthtists blocks, and as he said to me when I first met him they have to fix them.
So I dont think its goign to hurt seeing him, he may be better then the PM docs maybe?

You may be right I amy have been referred to see the shrink for an eval for the pump as I no longer take the antidepressants, lol its gonna be funny as I spent 4 years trainign in that specilialsty so it will be inteesting to see there take lol and to see if they make me lie on a bed hahhaa.
Might have s snooze if they do that .

I dont think my new Om doc whose HOd will ever let the swede near me again.. What will also be intesrtesint to him is that even tho he doubled my dose of MST and fast morphine I have not taken it and maintaine dth elower dose and got rid of 3 other meds. so he will now see how serious I am to get rid of these oral meds.He will also see me when I look moderately well and will now knwo that when I present its fr a reason and not my choice at a hospital as I have told him I hat ethem people die in there.

I looked up that serotonin link, that blew me awaway, i had the flu symptoms and teh throwing up for a few days but am better now. I tell you I wount be taking SSRI's again nasty things will stick to TCA's if anything.

For those that suffer constipation the most enlightening thing for me was that getting off those meds has meant that my bowels have starte dto work for the first time in 3 years, so they are rather constipating even tho we associate morphine mostly with that

talk to you soon

debs


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