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  • Pain Managament? Physctrist?

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    Old 05-27-2005, 09:45 PM   #1
    jenjordan
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    Pain Managament? Physctrist?

    I went to the spine center thursday and the doc there is refering me to a neurologist. Now heres my qyestion he said my pain meds needs increased,but since he will not be following my case he could not change anything. I take Lortab 7.5, Naprosyn, and flexeril. Now this is what I think he said I wanted to see if any of you had heard of this. He wants my PCP to refer me to a pain managment doc and a psyctrist(SP) to dispense my meds. Have any of you heard of this. I am diagnosed with PTSD anxiety and depression could this be the reason? Any thoughts. I dont see my PCP till June 10 unless i can get my appointment changed it seems unfair I have to be in Pain until I get all these appointments..............I guess I will know more when i see my pcp or the neurologist . So I guess my main question is have any of yoiu heard of having a phsyctrist dispensing pain meds?Lower Lumber L-4 l-5 ,pinched nerve I hope this makes sense
    Thanks
    Jenn

     
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    Old 05-28-2005, 12:35 AM   #2
    Tyneyboy
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    Re: Pain Managament? Physctrist?

    He may mean a physiatrist (fizz ee at' trist), which is a physician who specializes in physical medicine and rehabilitation. (Think a Physican therapist with full MD credentials and a prescribing pad). That is a very different kind of doctor that a psychiatrist, who specialize in mental problems - though a few of them do manage pain as well.

     
    Old 05-28-2005, 01:13 AM   #3
    jenjordan
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    Re: Pain Managament? Physchiatrist?

    Thanks so much I am not clear on which he said I was in alot of Pain after the 3 hour drive to the center and then his exam. I hope i dont have to wait 6 weeks to see the specialists like last time. I wonder if the doc who did my examine recomends to my PCP an increase in my meds (which he said I needed) if my PCP will do this? I dont want to sound like a drug seeker but i am in pain and have been for monthes. So frustrating

    Anyother comments welcome

     
    Old 05-28-2005, 06:22 AM   #4
    ARANGER
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    Re: Pain Managament? Physctrist?

    Your PCP can write meds and hopefully will write at least something to get you by. I see a physiatrist for pain managmement. He does injections and writes my meds. Most require a contract with them. I would talk with your PCP about what the other doc said. Sometimes getting in with a physiatrist can take some time. I would explain that situation to your PCP.

    Good Luck

     
    Old 05-28-2005, 07:36 AM   #5
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    Re: Pain Managament? Physctrist?

    Hey Jen, I thought you had surgery scheduled already, Change of heart?
    Physical medicine covers alot of different techniques and modalities to manage pain, everthing from trigger point injections to ESI's , PT some Physiatrist do chiropractic type manipulations, some do acuppuncture, use tens or do TINS. There are all kinds of nerve blocks to try, but these smply mask pain, they won't reduce an impinged nerve. Pain mangemnt is just that, it's simply tryng to manage your pain, It won't fix anything. If your sciatica is from an impingement nothing any PM doc does will correct it or the other bulging discs.

    You let the cat out of the bag with your acknowledgement of previous history and use of meds for reasons other than pain, you can't undue this and it will follow you, there are dozens of modailties to try to manage your pain before someone deems your pain is intractable, inoperable and your only option is opiates for pain relief. Docs aren't being cruel by trying other methods aside from the one you know will work. It may even be for your own good whether you believe it or not.

    Avoiding surgery nobody wants to have becaue you can find a doc willing to treat your pan has consequences. Just things you need to consider when it's hard to think of anything but pain relief. But nobody is really doing you a favor by maskng a problem that could have been fixed and leaving you in a posotion where your only option becomes pain management. Right now you have options. In a year you may have none.

    The all have their own idea of what works and what doesn't. As far as any new doc or PM doc taking overprescribing, they bvioulsy want to contact your other docs to be sure they are the only one prescribing. Some believ antidepressants are the key to manageing pain, some use anti seizure meds like neurontin, toppamax lamyctyl and many others. It's al trial and error.

    I do think people should have a choice regardng surgery or trying pain management, however these PM docs need to explan the possible consequences of not having surgery, trying everything under the sun , then deciding only opiates will help. You can only mask a mechanical disfunction that neds to be fixed for so long. If everything was stable and you were left in pain after surgery, that's a little different, but to put off surgery and try everything possible to prevent it, including opiates, you may miss the window in which you could have had a succesful surgery.

    Acute pain turns to chronic, the gateway theory kicks in and even if the impingement on the nerve is removed, the gates that allow pain signals through are stuck open, pain is imprinted into nerve tissue and no surgery will relieve your pain even when a compressed nerve is obviously decompressed. There is a risk to not having the problem fixed surgically, and that risk may be loosing the chance of ever having it fixed and spending the rest of your life looking for a way to manage pain that could have ben fixed from the get go.
    Every PM doc has a different view of opiates, there are plenty of PM docs out there from every field that don't believe in their benefit.

    I know you just want pain relief, but if the answer is surgery and you choose somethig else, surgery may not be an opton down the road. PM docs need to exlpain this and the gateway theory and explain about pain imprinting into nerve tissue. What you may have fixed now, may not be an option in a year from now when you can no longer mask the pain because it's a mechanical problem that should have been fixed.

    You will still have the mechanical/structural problem, simply masking it untill you feel ready could have a very negative impact on the posibility of succesful surgery or even finding a doc willing to operate.

    Good luck, Dave

    Last edited by Shoreline; 05-28-2005 at 01:02 PM.

     
    Old 05-28-2005, 01:07 PM   #6
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    Re: Pain Managament? Physctrist?

    Hey Dave
    No I have never had surgery scheduled.......just a myleogram and now that has been changed to a EMG. My PCP is the one who diagnosed me with PTSD and prescribes "all" my meds now. I dont know what made the doc I seen Thurs deciede to change it to an EMG.....I am frustrated I will have another long wait to find out what is causing all my lower back back pain and numbness of right leg foot and hand. The doc I seen Thurs says he thinks its a pinched nerve ..............thats what I keep hearing from PCP, chiro........so I am just waiting for an appt to be scheduled at the neurologist,.

    Jenn

     
    Old 05-30-2005, 11:09 AM   #7
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    Re: Pain Managament? Physctrist?

    My Physiatrist has quite literally saved my life! PLEASE DON'T BE DISCOURAGED: "I am frustrated I will have another long wait to find out what is causing all my lower back back pain and numbness of right leg foot and hand. The doc I seen Thurs says he thinks its a pinched nerve" My experience is that everyone else is satisfied to "guess" what is going on w/you based "their years of experience", while the physiatrist is going to do things that require him/her to be more of a "scientist" than that. You can't go around "sticking needles into the nerves in people's backs" if you don't know what's wrong for example! I hope you get a GREAT DOC! MINE (not my PCP) is the one who makes referrals to Orthapedic surgeons (my ins requires my PCP to "sign off"--but he's so happy not to be involved he'll sign anything). He also is an expert at such things as radiofrequency denervation (which I am having Wednesday). My situation is this: just turned 40, bulging, herniated and generally deteriorating discs in my cervical, thoracic, and lumbar spine, as well as lateral recess stenosis. I also have severe facet joint osteoarthritis EVERYWHERE (the Physiatrist was actually horrified). I spent FIVE YEARS with my PCP telling me there was no good reason to waste the ins co's $ on MRI's, went through THREE PCPs. Found one w/compassion--he doesn't "do" pain meds. So... I obviously have reason to think my Physiatrist is just shy of GOD--seriously! I HOPE IT GOES AS WELL FOR YOU--GIVE THE DOC A CHANCE. It DOES take a long time to get into Pain Management/Physiatry (like most new docs)--but once you're on their schedule, you should be on a reasonable rotation. Also, they don't freal out about narcotics. I remember mine saying, "Okay, I can write you a few Percocet until I see you again in 3 weeks." He wrote for 90. Usually when a PCP said "a few" it mean 10, or something like that. On a personal note, I feel like I'm in left field or something. I'm surprised at the dosages written by folks on the board. I was on MSContin (Extended Release) 30/30/30 w/Percocet 10mg 1- 2x daily for breakthrough--and my doc was talking about making a switch b/c he said that was a "scary big dose of meds". Right now I'm on plain Oxycodone (no tylenol added) up to 60mg daily (no morphine)--and he says we have to re-look at the meds after the denervation as he is uncomfortable w/this--frankly so am I as it's not providing great pain control and neither did the morphine. I've also been on a fentanly patch--but no higher than 50mcg--so that was not too effective. Obviously good enough for me not to be pulling my hair out though!!!

    Last edited by dango; 05-30-2005 at 11:28 AM.

     
    Old 05-30-2005, 11:37 AM   #8
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    Re: Pain Managament? Physctrist?

    PS/I forgot to say that I am prescribed psychiatric meds too. It's not considered a BAD thing by my physiatrist. Turns out one of the meds I take also helps w/pain control, so I actually increased the dose (topomax). Things like neurontin and clonopin also help w/pain--but the doc has to okay any kind of increase.

    Last edited by dango; 05-30-2005 at 11:40 AM.

     
    Old 06-03-2005, 02:54 AM   #9
    jenjordan
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    Re: Pain Managament? Physctrist?

    thnks newbie
    Welcome sorry I have not responded sooner. I have been in alot of pain lateley and literally done as in bed from pain I do appreciate all your kind words.
    Keep wishing me luck for a fast appt
    Later
    Jenn

    Last edited by jenjordan; 06-03-2005 at 02:56 AM. Reason: spelling

     
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