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  • Pain Management --- May Not Be Worth Going!

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    Old 03-12-2008, 01:29 AM   #1
    sherry1
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    Pain Management --- May Not Be Worth Going!

    Hi all

    My doc referred me to pain management so last week i had my first appointment.

    At least thats what me an my doc thought it was going to be!

    In actual fact it was to see a pain consultant who basically said there was nothing more that could be done for me and referred me to pain management which will take another 3 months.
    Its always aslap in the face when the docs say that to me and basically he implied its all in my head!!
    WHAT? I said 'i can asure you it's definately in my back'!
    I was so cross.

    As it is my i have discussed this pain management with my doc and thinking as they do everything that i went through at the beginning of my back problem it may not be worth going.

    Physiologically i have come to terms with my problem and am coping very well and am trying to get my life back together while living with the pain and am coming down on all my meds because they dont help anyway.

     
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    Old 03-12-2008, 12:12 PM   #2
    cmpgirl
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    Re: Pain Management --- May Not Be Worth Going!

    Hi Sherry: I know that in many cases chronic pain patients have to go through a psychiatric evaluation, before seeing the actual PM doctor. I think that is actually required in some states here in the US. Sounds like that is what happened in your case.

    There are many things a PM doc can do for you, aside from the meds and I think you should give it a fair shot. I'd hate to see you miss out on a possible "good thing", just because one doc wasn't helpful. Maybe pain management is not the option for you, but it has helped so many of us.

    Best of luck, whatever you decide, cmpgirl

     
    Old 03-12-2008, 07:24 PM   #3
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    Re: Pain Management --- May Not Be Worth Going!

    Hey Sherry. I know that coming to grips to being referred to PM can be tough. When I was referred, my family Doc told me that "we send patients off to pain mgt when we can't do anything else for them and have other place to send them to." What a jerk! While technically true in some cases, there are other ways of say it!

    IMO, pain mgt is a cost to benefit ratio. Is the "cost" greater than the "benefit"....i.e side effects, dependence, & etc.......Or does the "benefit" outweigh the "cost"....ie the ability to function somewhat normally, enjoy some parts of life and family, greatly reduce suffering, & etc. For me, my "benefit(s)" clearly outweigh the "costs." Granted, there are many "costs" I don't enjoy, but the "benefits" are very worth while. Would I rather be pain free and not taking any meds....ABSOLUTELY. But, I'd rather be in the boat I'm in than in pain.....suffering and my boat taking on water.

    Also, it's important to know that the process you're going through, although a pain in the butt, legitimizes everything so you can be prescribed the meds you need worry free. Good PM Docs have a rigorous process in order to protect all involved. Although I have to admit that I sometimes get frustrated by how strict my Doc's office is, it's also reassuring to know that the chances of some severe addict or diverter infiltrating my Doc's office is very slim.

    Good luck and hang in there!

    Ex

    Last edited by Executor; 03-12-2008 at 07:28 PM. Reason: spelling

     
    Old 03-12-2008, 07:45 PM   #4
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    Re: Pain Management --- May Not Be Worth Going!

    Quote:
    Originally Posted by cmpgirl View Post
    Hi Sherry: I know that in many cases chronic pain patients have to go through a psychiatric evaluation, before seeing the actual PM doctor. I think that is actually required in some states here in the US. Sounds like that is what happened in your case.

    There are many things a PM doc can do for you, aside from the meds and I think you should give it a fair shot. I'd hate to see you miss out on a possible "good thing", just because one doc wasn't helpful. Maybe pain management is not the option for you, but it has helped so many of us.

    Best of luck, whatever you decide, cmpgirl
    Hi,

    I have a pretty lax pain doc, he's a PM&R guy, and we have no contracts, or drug tests, or any of that, so I'm very lucky. I'm just wondering, what are they looking for when they do a psychological evaluation? Will they not let you participate in pain management if you're, say, depressed (which obviously is apparent in a LOT of CP patients)? I'm just curious. Thanks!
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    Old 03-12-2008, 08:59 PM   #5
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    Re: Pain Management --- May Not Be Worth Going!

    Quote:
    Originally Posted by lizzybrog80 View Post
    I'm just wondering, what are they looking for when they do a psychological evaluation?
    Lizzy- The purpose of this stage of the referral is to do a complete psychological work up on the patient to ensure there aren't any other underlying issues. For example, many Bi-Polar & ADHD patients have self medicated and/or used narcotics as a way of dealing with their respective condition(s)....Not that the pain isn't necessarily there...It may be....Or, it be greatly exaggerated or none or all.

    Thus, these evaluations ensure that patients are directed to the proper care that they need....Which is the real issue. Secondly, the evaluations are also a useful tool in weeding out many of the drug seekers or diverters. In order to make it to the PM Doc, not only do you have to be referred by your PCP/GP, but pass this psychological exam as well.

    The end result is that in most cases, the PM Doc has a client list of solid, reputable patients that are there for the right reason(s). The benefit to the patient is that (1) He/she gets the care they really need and (2) Because of these stringent acceptance standards, these Docs have great relationships with the DEA and are much less likely to be infiltrated by a abuser/diverter. Because of # 1 & 2, these Docs often are fairly aggressive in their treatment plans, which is also good for the patient in the long run.

    While less hassle up front is good in some respects to those who are really in pain, it can be more of risk overall because if a big time abuser/diverter infiltrates that practice and later gets caught, a Doc's office can be shut down overnight. I think just about every major area has had at least one pain Doc shut down by the Government at one time or another. Part of them are bad Docs, but the biggest issue is lax standards that are eventually taken advantage of by abusers, and thus, the practice is exposed.

    As many can attest, PM is a very complex field today, and only getting more so. My office now requires a photo ID at every visit due to "patient identity theft." Amazing isn't it??

    Hope this answers your question.

    Ex

    Last edited by Executor; 03-12-2008 at 09:00 PM. Reason: spelling

     
    Old 03-12-2008, 09:13 PM   #6
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    Re: Pain Management --- May Not Be Worth Going!

    I know my prescribing doctor sent me to a psychologist just to make sure there is nothing else going on and to get a second opinion on my pain levels. When I saw the psychologist, believe it or not he diagnosed me with anxiety and depression ontop of uncontrolled pain!!

    I think this is a normal step - just a cross check.

    Last edited by ms_west; 03-12-2008 at 09:20 PM.

     
    Old 03-13-2008, 10:45 AM   #7
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    Re: Pain Management --- May Not Be Worth Going!

    Quote:
    Originally Posted by Executor View Post
    Lizzy- The purpose of this stage of the referral is to do a complete psychological work up on the patient to ensure there aren't any other underlying issues. For example, many Bi-Polar & ADHD patients have self medicated and/or used narcotics as a way of dealing with their respective condition(s)....Not that the pain isn't necessarily there...It may be....Or, it be greatly exaggerated or none or all.
    I know this is why they sent me through all of the doctors and psychiatrist and counselor since I do have bi-polar and I have abused narcotics before to self-medicate my physical pain & possibly emotional/mental pain. However, I am doing all of the "right" things and taking my meds like I am supposed to and not doing anything illegal. That is a good feeling especially when I pass a cop and don't really have anything to worry about. Of course, I still get a little bit paranoid when I see them. OK, maybe I said too much, ooops.

    Brian

     
    Old 03-13-2008, 02:07 PM   #8
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    Re: Pain Management --- May Not Be Worth Going!

    Brian:

    My PM clinic does all of those things you mentioned (Full Psych eval) on EVERY patient just as a matter of routine. Their clinic is considered a "one stop shop" in terms of PM care. They offer just about every modality available to PM with the exception of accupuncture, including psychotherapy. It's nice to do it all in one location. It also makes it easy in terms of Insurance billing. I don't have to worry about whether or not it will be covered if prescribed by my PM.

    I myself have participated in PT, psychotherapy, massage, biofeedback, trigger point injections, ESI injections (but they were done outpatient at the local hospital under twilight anesthesia and with flouroscopy) and a few other modalaties that I can't remember right now at this one clinic.
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