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danielle2291 12-16-2006 04:54 AM

my pain management visit-does this sound right?
I went to see a pain managment doctor yesterday for the first time. I went because my orthopedic surgeon recommended that I go. I was in a car accident a year ago and I still have back and neck pain as a result of it. My pain varies from mild to moderate but it is there every day. I have been in and out of physical therapy and have done a total of five months of therapy throughout the last year. I have tried a variety of prescription anti-inflammatories which don't really help with the pain. Some take the edge off, but they never fully take the pain away. An MRI of my back showed that I have a mildly bulging disc. My orthopedic surgeon agreed with the radiologists finding. So, yesterday when I see the pain managment , he tells me that my MRI looks clean and that he doesn't see a bulging disc and that if you look hard enough at any MRI that you can find something wrong with it and that all doctors interpret them differently. He looked at my range of motion which is good and basically told me that I need to go home and start a good core strengthening exercise program. I tried to tell him that I have been doing that for the past two months in therapy and that it has provided some relief, but I still have pain. He said that based on my MRI and how I present clinically that I am not a candidate for any type of steriod injections and that they would not help me. I am fine with that b/c I by all means don't want a procedure that I don't need or won't do anything for me. I asked him about taking anti-inflammatories and he told me that yeah, I can take them if they help. He told me to take motrin or alleve. I told him that they don't do anything and he indicated that there is probably no sense in taking them them. He didn't offer to work with me to find any kind of prescription anti-inflammatory that my body responds to. He told me to give the injury more time to heal. I told him that I have given it a year and how much time should I give it. he told me about some shoulder injury that he had for two years before it went away. He told me that he believed that I was in pain and that I just had a bad muscle/ligament strain and essentially that I needed to learn how to cope with it....that football players get injured and they learn how to cope with it. I almost started crying right there at the visit. I couldn't believe that he thought that I would waste my time and take time off of work for him to tell me to go home and do what I am already doing. I thought that the point of a pain managment doctor was for them to work with you to help you find a way to cope with your pain? I didn't go to him looking for narcotics b/c I don't have pain that needs narcotics on a daily basis...sometimes yes, but definately not every day. I put on my pain questionairre that my pain varies from mild to moderate. Is that why this doctor blew me off? I am 30 years old and I don't think that I should have to live with pain everyday for the rest of my life. Can someone tell me, does this sound like I had a bad visit with a pain managment doctor or is this how all of them are? My boyfriend thinks that I should go and get a second opinion, but if this is what they are all like, I don't see the point. My PCP is more willing to work with me for pain relief than the pain management doctor. I know that I shouldn't complain b/c I know that there are a lot of you out there who have much more severe pain than myself and I sympathize with you. I just didn't know where else to vent. Danielle

conductor 12-16-2006 08:03 PM

Re: my pain management visit-does this sound right?
Dear Danielle,

This doesn't sound right, BUT it does sound typical. PM docs vary in their approaches, so a 2nd opinion might be your best option. The one thing I've learned is that the most a PM patient should expect is approximately 50% relief. The expectation of complete, 100% relief will usually leave you disappointed!

His whole "theory" about MRI interpretations is strange to me. If something is visibly "wrong"--then it is proof that something is wrong.

Certainly, no one can guarantee a better visit during a 2nd opinion. However, let the doc know what you have tried. The doc is the boss, but it is important for the doc to know what has NOT worked for you over this past year of treatment.

Go in with a hopeful attitude that you will not permanently need to be a pain patient, but let the doc know that you are looking for reasonable relief.

Please keep us posted because we want to know how things progress!

Jon (Conductor)

zuzu23 12-16-2006 11:39 PM

Re: my pain management visit-does this sound right?
I read your post earlier but had some major things to deal with, but I just wanted to tell you my opinion, if that's okay :) I agree with Conductor, that a 2nd opinion is needed. Your doctor's quacked-out "theory" on MRI's is dumb....I had a doctor who talked like that once. An internist who looked at anatomy as "philosophical."

Here's a sort of similar example: since 2000 I have had a goiter (large mass, tumor) in my neck & also extends deep into my chest. It bulges way out & my thyroid gland is currently 56 X the average size. It's disgusting to me, and for a relatively thin person, it looks even bigger. People ask me all the time, you know in Safeway or Walmart or a waiting room, what's up with my neck.

Anyways, my blood disorder doctor noted on my physical in 2000 that is was very large and would require surgery and the surgeon should call him to get it all arranged so it's safe. Then, over 5 years later, my very 1st Endocrinologist (thyroid doctor) said it was SMALL and didn't quite need surgery yet lol. He said that people in Africa are the ones who need surgery and not me (in many countries, the water supply's not iodized which can cause MASSIVE growths; theirs can often extend out 2 feet wide.) So I left his office, and while I was walking out, over my shoulder I said, "Go operate in Africa then. Cause Canada sure as hell can do without you." Anyways, when I saw three surgeons this year, the first two have told me that the growth is now too LARGE for surgery here; they both said that "grossly massive" tumors can only be removed in Toronto or the Mayo Clinic in the States in a patient with my blood disorder and other conditions. The first surgeon was a "rare-disease high-risk" doctor, and she wouldn't even touch it!

So obviously, the moral of my story is that "experts" or specialists can definitely be wrong, and I think you need to get a 2nd opinion, or a 3rd even. Keep going until you feel that you're being taken seriously and not just dismissed. Every human being deserves that measure of respect; demand it! People will only treat you as bad as you let them. You are worth it, and are entitled to respect and appropriate proper medical care. Advocate for yourself if you're unsatisfied, and insist you are worth a second medical opinion.

djemcee 12-18-2006 10:57 PM

Re: my pain management visit-does this sound right?
I basically told my doctor what I wanted, not what I would like to have. Be very clear and tell the doctor you WANT pain relief, and you DEMAND help. Many times a passive attitude get's you out the door.

Good Luck,

Keep us posted.

Linda Hull 09-15-2010 02:38 AM

Re: my pain management visit-does this sound right?
No this sounds typical. Next time you in in one of these doctors offices take a tape recorder hide it in your purse. This is important. If you are on medicade or medicare and you get treated like crap, Call and write a letter to medicare, medicade or your personal insurance company and tell them this doctor did nothing and do not pay him for his non service if you have been forced to pay for services yet rendered , especally if they say they accept medicare and medicade.. Usually they will try to get you to pay up front, If so ask why as you have not as yet been given any service-have tape recorder with you, in case they deny you service for not paying prior to service rendered. Call your Senator over helathcare for your state and tell them what was not done how you were treated, and after going to doctor after doctor and getting no help take the tapes in personally to your district Senator over healthcare and play them to the person you are speaking with , show them the records, make sure to get records and if on medicare/or medicade ask why medicade or medicare paid this doctor. When the doctors stop getting paid by your insurance companies any and all insurance , I am sure the insurance company's would love this- including medicare and medicade,that is when maybe something might change as money always talks.

Shoreline 09-15-2010 09:55 AM

Re: my pain management visit-does this sound right?
Hi Danielle, If your not going to be satisfied untill all your pain is completely relieved and vanishes or is taken entirely away by medication, your going to be continually disapointed. Even those of us on high doses, With implanted pumps, must learn to deal with some pain. An implanted pump like I have that delivers dilaudid directly to my spine is considered succesful if it relieves 50% of the pain and that's about the best mine does. I have broken hardware at 6 levels in my spine, 3 fusions have failed and I will be in pain the rest of my life, It's already been 17 years and I haven't died yet. The only way I wouldn't be in pain would be complete sedation and no doc is going to put me in a coma the rest of my life.

If that doc reviewed your files and did a physical exam, he did perform a service that he deserves compensation for. If your expecting him to relieve all naggng pain from a major injury, which is why he compaired it to a fooball player that's had multiple reconstructive surgeries is right on Q with chronic pain and pain management. That's why it's called Pain management, not Pain elimination or irradication. The only thing that would relieve all pain would be to simply numb you with a local and that's going to wear off in a few hours. Part of the evaluation process is patient expectation. If he knows you are never going to be happy as long as you have any discomfort, you will never be satisfied and quickly become a problem patient.

Medicare doesn't require anyone to give you all the meds you want untill your pain free, Sadly most of us do have to learn to cope with some degree of pain following a major injury, whether it's at a point that requires a docs intervention and the patient is suited for what the doc knows he can offer is determined at that initial consult.

I was at the PM doc the other day having trigger point injections done, The lady in the gourney next to me was waiting to have an injection done of her SI joints. When the doc came around and asked her what her present pain level was she said a two, The doc refused to proceed with the procedure and sent her home given the fact a 2 is something people can live with, He wasn't gong to do a procedure that required additonal radiation exposure and light anesthesia and all the risks involved to numb her completely for 4 to 8 hours so that she could report 0 pain when asked following the procedure. I know this isn't what you want to hear but it will save you a lot of time, money and embarrasment. That's not what pain management is about. If that's what your looking for, you're not going to find it. Ask your surgeon to numb you up for a few hours if you simply want to be completely pain free for a few hours. However there is a good chance if he thought that would satisfy you, he would have already done it and goteen to charge you a couple hundred bucks for something very short lived. I would kill to be pain free for 6 hours, Other than an epidural block from T10 down, It's never going to happen, not to mention I would have to be cathed and their is risk of spinal cord puncture, leakage, infection and potential nerve damage for a couple hours of relief from a lifetime of life altering pain.

Many PM docs partner with pain psychologists so these types of expectations can be dealt with and ways of coping with lingering pain can be tought. Good luck, Dave

janiee08 09-15-2010 10:56 PM

Re: my pain management visit-does this sound right?
I doubt Danielle will read any of this since her post is dated October of 2006.Just sayin'....janiee

NOTSONUTSO 09-15-2010 11:14 PM

Re: my pain management visit-does this sound right?
[FONT="Comic Sans MS"][SIZE="4"][COLOR="Red"]Thank you, Janiee08! Once again I clicked on what I thought was a new thread only to find it has been ressurected from almost 4 years ago! It used to be against the rules of Healthboards to comment on old posts; if the rules have changed I'm not aware of it. :dizzy: [/COLOR][/SIZE][/FONT]

Shoreline 09-16-2010 01:09 AM

Re: my pain management visit-does this sound right?
LOL, perhaps some of the newbies waiting for their first apt may get something out of this. One: you can't sue a doc for not giving you what you want, Two: if you pain level is a 2, Don't have invasive procedures done, Buy some advil and learn to except the limits of medication and PM. Today was my recovery day from working 8 hours yesterday, :dizzy: perhaps those waiting for their first PM apt may get something out of this thread, although I thought we weren't supposed to resurect Zombie posts.

jayman920 09-16-2010 10:29 AM

Re: my pain management visit-does this sound right?
why would you tape the dr? that makes no sense. the dr looked at you and his prof opinion said you would not benifet, he could have milked the insurance company for thousand of dollars but he was honest and did not. your age plays a factor most pm dr's will not write pain meds for ppl under 40. if your primary dr will help you with your pain go that route

NOTSONUTSO 09-16-2010 02:03 PM

Re: my pain management visit-does this sound right?
[FONT="Comic Sans MS"][SIZE="4"][COLOR="MediumTurquoise"]"Zombie posts!" LOL, Shoreline! :cool:[/COLOR][/SIZE][/FONT]

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