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    Old 02-12-2009, 09:15 PM   #1
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    Injection and pain mgmt problem

    I will be brief as possible. In May 06 I was prescribed vicodin by my family doctor for lower back pain. After an MRI and a dismissal of interest by an orthopedic doc in Aug of 07 the family doctor referred me to a pain management doc. The pain management doc began a series of 3 injections within a 3-4 month period and had me sign a "contract" stating he would assume all pain meds. The pain was relieved by the shots especially down my legs. The 4th shot which had to be postponed until necessary (cannot have more than 4 in a year I think) was given in Aug of 08. After each injection the pain doc would leave a voice mail checking the condition of my pain although I never talked to him personally. I never had to return his call because I was doing fine. In Sept of 08 I started another round of these injections and the relief was in check and his call was made again to check the progress. In October I went in for the second shot for the treatment year. Immediately after I got the injection my back began to hurt like it never had at the location of the injection. I missed his call the following day as usual but called a week later and left them a voice mail that I was experiencing some moderate to sever pain. Just riding in a car and hitting a bump would bring tears to my eyes. Two weeks went by and I called again asking to be referred to an orthopedic or neuro doc. No response by the office for over a week. (I forgot to mention that during the last visit prior to the injection I had asked the pain doc if we should explore going to a Neuro or Ortho, he said not yet that he would try something called "fawcet" injections). Anyway after about three weeks of trying to let him know I was in severe pain by now his office called and referred me to a neuro. By now it was December and the wait to see the Neuro was 6 weeks. In the interim my family doc ordered another MRI, prior to getting the results of this MRI I called my family doc and told him the pain was intense. He prescribed Vicodin 500/5 I think and 10mg Oxycontin. In the meantime I had a previous RX from the pain doc that was due to expire at the end of the month. One week expires from the visit to the family doc and I get a call from his nurse assistant to come in the next day (this is very unusual and it scared me because I had just had the MRI and thought something serious was going on). So I go in and he rips me a new one saying the pain doc had run a CASPER report and said I was abusing drugs and shopping doctors, he threatened to involve the local Narcotic.s department because I had gotten another script from someone other than him and I had signed a form. (by the way I never picked up the new RX and put the script on hold at the pharmacy. Ok, back to the ripping.....I got mad at my family doc and told him I never filled the rx and that I was in pain and didn't appreciate being labeled a drug addict, I am in pain and all I want is relief of this problem. The MRI report was on his clipboard as he was ripping me.....when the conversation was over he began to walk out I stopped him and said "well what about my back and the MRI report? He stopped and said "oh you do have a report here", I was very livid at this point. He read it and it said I had an A-Typical Hemangionoma on my spine. I asked if the pain doc could have hit it during that shot in Nov. he said it was possible but that is why I signed a hold harmless agreement with him and sometimes things get worse with your back.
    So now I am awaiting the appointment next week with the Neuro. In the meantime since the last shot in Nov I have not been able to sleep in a bed, I have slept in a recliner, I can't walk straight, I can't drive long distances and am in constant pain. I have since seen the family doc again to refill the meds because you have to see him once a month to get refills and can you believe he asked if I wanted to up the dosages of the vicodin and oxycontin???? I refused to but have been in bad pain. I am going to see the neuro and ask if the pain doc could have stuck this tumor thing in my back causing the current issues if so I plan on seeking legal advice against him.
    Thats pretty much the deal right now, I hope there are readers that can use this info when contemplating a pain management doc. My experience is that all these docs are just out for our money and to save their asses and really not concerned about our pain. I got labeled a drug taker and I am upset like you can't imagine about this and if my suspicion that the pain doc really hurt my condition is confirmed by a neuro I plan on suing him once I am taken care of. My life has been crap since he gave me that last injection. I wonder if anyone else has been labeled like this and or been hurt like I claim has happened to me?
    Thanks for reading

    Last edited by M08; 02-15-2009 at 09:29 PM. Reason: Questions may not be posted in the pain mgmt story board; therefore, your post has been moved to the pain mgmt board.

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    Old 02-18-2009, 07:08 AM   #2
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    Re: Injection and pain mgmt problem

    i dont think i would sue, i wouldn want to get black balled from treatment. no other dr. will treat ya i bet.

    Old 02-18-2009, 09:26 AM   #3
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    Re: Injection and pain mgmt problem

    while i really cannot state too much about the legal part of things,the one thing you did wrong here was simply accepting another narcotic RX while STILL under contract to your PM. that is a no no in the PM world,that is why they got a bit POed with you there. did your PM actually use flouroscopy during that procedure to help guide needle placement? if things showed up on a screen during that procedure,then he did. if not,anything is really possible as far as what could have been hit during that procedure.

    what i am wondering about is just what is in the summary at the very end of your MRI report,both of them,the first one where the ortho blew you off and the second comparative study. one word to be looking for in that second MRI report is the word 'hemosiderin' somewhere in connection to that hemangioma. if that word is there it means your hemangioma has bled and left behind that hemo staining. i had one of these little SOBs inside my actual cord inthe c spine area. mine was not just 'on' the spine. i am wondering about the word "atypical" in the description of it tho. did they explain that at all to you?

    what a hemangioma actually is is just a glob of vascular veinous fed vesels(a form of vascular malformation that you were more than likely just born with,not actually a form of 'tumor" but a lesion). what i am wondering about is that atypical part. i would ask that neuro(is this an actual neurosurgeon or just an ologist? cuz you DO need the NS not ologist here)is why this is mentioned as 'atypical"(meaning 'not typical") and not 'just' an hemangioma? you know what i mean? something about this is different from the norm,that is why atypical is there at all. you simply NEED much clearer definiteion of is this actually a real hemangioma or even a possible AVM or some other type of vascular malformation that is just possible to have in both the cords and brains too.

    i had to have an actual angiogram done on mine just to see if it would light up. if it did,that ment what i had was arterially fed not just veinous. this just needs much better definition to really know what it actually is. do they give any approx measurements of this malformation at all?

    like i asked above,if you could actually just type out both summarys it would REALLY help to give you the best help possible. alot of the way any rad actually types out and words any finding can tell alot,that is why i really would like to see how this was mentioned,along with any other possible findings in that summary that could be contributing to your situation. once you can give me this info,i will at least be able to better see what they may think the atypical part of this actually is. just exactly where,is this located within your spine,at what level and aspect of the vertebrae? any hard info you can give me would help tons to help you. Marcia
    3-22-01,herniated C-6-7
    11-20-01,placement of hardware for failed fusion
    9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

    Old 02-19-2009, 07:21 AM   #4
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    Re: Injection and pain mgmt problem

    It's such a racket, isn't it? I just called my ortho yesterday because the 5/500 vicodin he's had me on since oct, isn't working. he had told me to double them, but that didn't work either. whenever he's offered me more vicodin's, 2/3 times i say no..because 1) they don't work very well and 2) i don't want to build up a tolerance to the only thing i have to help me at this point.

    so he sends me to a pain management doc for an epidural. felt relief for 24 hours, but back to pain again. i call my ortho yesterday to see if there is another type of med which would last longer and be more effective, and he said he wanted to keep me on vicodin since my second epidural (next week) should help me out. it better because i will be s.o.l

    Old 02-19-2009, 07:37 PM   #5
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    Re: Injection and pain mgmt problem

    I understand your frustration and anger, however the people on this forum are simply providing you they're opinion as well as suggestions and whether you agree with it or not the facts are that you signed a PM agreement more than likely saying that your PM doc was the ONLY doc allowed to prescribe pain medications for you. It doesnt matter that you didnt get it filled, you still recieved a pain medication from another doc other than your PM doc which goes against all PM rules and will more than likely get you kicked out of that PM practice.

    We all suffer from pain here and most of us hate the rules and policies of many of the PM docs, however in order to get treated for our pain, we have to follow they're rules or they wont treat us. It is very hard for a PM doc to trust a new patient, simply because of all the street abusers that are getting PM docs locked up ect.... So alot of them do not like to write for pain medication even though this is the profession they are in and almost all of the PM docs will want to do other procedures such as the epidurals and injections.

    I just had a friend of mine who had some kidney stones, the largest one was 3mm and he went into the hospital in severe pain, the hospital took him in immediatley for surgery and blew up or disentigrated the stones, they were going to send him home with scripts for pain, however he told them that he could not accept them because he was under a PM management contract and it would violate the agreement. He went home with no scripts and only took what his PM doc has been prescribing him for his other problems. He wasnt happy that he had to turn away the scripts and use his back medications for kidney stone surgery, but he was not going to risk being kicked out of his PM docs office. While he was in the hospital over the weekend as well, his pain was not being managed properly because he has a very high tolerance to meds, it wasnt until he threw a fit and demanded that the anethesiologist contact his PM Doc so that they could speak with eachother about increasing his pain pump meds, only then did the anethesiologist agree to increase his doseage while in the hospital.

    It obvious that your upset and angry and i'm sure in alot of pain and none of us like being in pain, but unfortunatley many of us are made to remain in pain for some time before we find a doctor that is willing to treat it correctly. when I suffer, I want my pain managed yesterday, not in a couple days or a couple weeks to see how a medication works, but thats just not how it works. Believe me when I say that many of us, would love to be able to get meds from a PM doc as well as a family doc or some other type of doc, but we cant, and we have to play by they're rules in order to be treated. I cant tell you how many days I had suffered because of a med that didnt work, but the doc wouldnt change it until I gave it a week or two, or because I couldnt get in right away to see a doc.

    I am now seeing a new PM doc, that is VERY strict. In that they will not write another script until you are on your 29/30th day of medicine and due for a refill. They give urine tests randomly, they want to use me as a pin cushion with injections and epidurals even though i've gone through them a few times already and they've been documented as making my pain worse. I've never had to go through this before. I USE to go to a doctor who would write my refill scripts a week and half early before they were due, never urine tested me, never had any issues with switching medication if I asked, never had any problems with increasing doses if I asked, never had my sign a contract, never did pill counts. So this is all very new and very strict for me and believe me it was very very difficult to get use to, but I learned very quickly that if I didnt follow they're policy's to the T, I would be let go and thats the last thing I want when i'm in pain is to be kicked out of a docs office and be black listed. All the doc has to do is call any pharmacy and ask them to block you and that block goes through a central system attached to ALL pharmacies that your blocked.

    All i'm saying is that if you want to be treated for your pain, there are rules your going to have to follow whether you agree with them or not, its just the facts of pain management. If you dont like the rules, you can always try to find a GP that is willing to treat you and is not as strict.

    Really the people here on the forum are great people and although they may tell you something you dont want to hear, they are being truthful and honest and trying to help you. Keep an open mind that some of the people here have been here for years and many have been in PM for yrs and know the ins and outs and can offer you some excellent advice and suggestions. We are all in the same situation here, we suffer from pain and we can help eachother out with what we know.

    I hope you are able to get the medications that you need and get your pain under control, i'm sure you'll be a much happier person when that happens.
    Best of luck to you,

    Old 02-20-2009, 10:06 AM   #6
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    Re: Injection and pain mgmt problem

    great post lisa,really.

    alvin,i know you are angery here but it would appear that you are more angry than wanting to actually figure out what it is you have that could be within itself causing you the pain you are feeling. when you enter the world of PM,it IS a whole other world, not the usual see your doc and get an Rx type of situation. you simply agree not to do certain things when you go there and sign that contract. whether or not you asked for that Rx or the doc offered it, you should have declined it or not asked for it period. the thing to do would have been to at the very least,notify your PM about the situation so at least they were 'aware' of your situation BEFORE they found it out by themselves. thats the key here. just basic communication with your PMs office. i have had to get alot of Rxes for other narcotics after every single surgery i have had. all i do (since they already know i am having surgery) is just leave a message on their nurse line telling them that my surgeon just rxed me this or that. if they have any questions they can call me about it.but so far they haven't.

    if you really honestly feel that you were indeed "injured' in some way by that injection(knowing if this doc used that flouroscopy i asked you about would help alot since they are required to for this)seek out an opinion on it. see another doc or get an MRI just to see what changes may have occured within that hemangioma. you don;t seem to really care that you have this glob in a your spine but just want retribution for something that you don't even know at this point is even an issue,ya know what i mean?

    with every single ESI and other types of injections i have had over the past few years,i have ALWAYS also recieved a big increase in my pain before things,if a good day,got better. right now you appear just so angry that you are not thinking about the real true things you NEED to be thinking about. there simply are alot of different reasons that you experienced what you did after that injection that need to be looked into. but you are not going to be able to really think clearly here about what IS the best thing to do until you calm down and stop thinking about sueing someone who may or may not have even played a part in what you are feeling.

    you REALLY do need to look at what you have been Dxed with and really look at that. alot of spinal issue can casue amazingly huge amounts of pain. you need help with this and thats not going to happen til you start looking at things with a bit less anger and more thought to what it is you are dealing with as your medical situation itself,ya know? obtaining an MRI would show in some cases,if there is indeed a hemosiderin staining somewhere or the hemangioma itself is actually enlarged,it could indicate whether or not this doc actually hit it. but hemangiomas themselves are very unpredictable with possible bleeds taking place even with a rise in blood pressure. i am just guessing here but given what we have read so far,i am kind of thinking you are one to stress out about things and also quick to anger as well? if that is indeed the case,you REALLY have to work on being on more of an even keel with that angioma sitting in your spine area. the one thing i was told when mine was found was to keep an eye on my BPs. the higher the overall vessel pressure gets,the higher risk of a bleed occuring,which WOULD possibly casue new or worsening symptoms/pain.

    i am only telling you this alvin becasue of what i went thru, i was not lucky enough to have this sucker just 'on or 'in" my vertebrae. no mine was created smack in the middle of my freaking spinal cord way up in my c spine. much worse area to have other than having one in the pons of the brain. the key here for you is to get opinions on just what this means for you and how to best deal with it. anything you really 'feel" about what this doc may or may have not actually done,really needs to kind of go on that back burner til you know just what it is you are dealing with here and the risks involved too. THEN,decide whether or not what you are thinking of still is worth it,the time and effort and expense involved. but your overall health just has to come first right now,and from what you have stated here,it is not,at least not from what i got from your post.

    just find out everything you can about your overall medical status and go from there. but right now,you simply really do not know whether or not anything was actually 'done' to you,ya know? i really do wish you luck withthis. i was only trying to help with info which is what i am also doing here. we are in the very same situations as you are,so please do not forget that. just trying to help out a fellow pain sufferer,thats all. Marcia
    3-22-01,herniated C-6-7
    11-20-01,placement of hardware for failed fusion
    9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

    Old 05-02-2010, 02:39 PM   #7
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    Re: Injection and pain mgmt problem

    It has been "implied" several times that I am looking for drugs even though I have never asked for a narcotic in the 4 yrs I have been in pain management. I have a small makeup case full of meds that did not work so I quit taking it. i have methadone, codeine and fentayl patches. if i was an abuser, I certainly wouldve used these up for sure! The only pain pill I have been able to tolerate is hydrocodone (loritab, vicodin, whatever u want to call it). Just this last Wednesday, my husband came home from work, found me laying on the bathroom floor by the toilet crying my eyes out. He insisted I go to the ER and get the pain under control. I went to West Florida hospital ER, they knew I was a pain mgmt patient but checked me in and put me on a gurney in the hallway of the ER, no room available. When the dr came over, I told him I had overdid it on Monday doing some yardwork, I couldnt get the pain under control. I hadnt slept in 48 hrs and been vomiting due to the severity of the pain. He said Florida law clearly states that only one dr could treat you for pain and he wasnt giving me anything for pain...if I thought i was gonna get narcotics there, i was wrong. Duh! I had my own narcotics. He said this was the ER and he had patients to treat, my husband asked him to please do something for me, he said he was too busy. My husband then asked him to call my pain dr, he knows he would tell him to treat me. The dr again said he was too busy to mess around calling my doctor, he had patients who really needed his help. It was the most humiliating experience of my life, I got up, ran to the payment office, told them to give us our co-pay money back. The girls there could hear what he was saying to us since I was right in the hallway. She called her boss about the refund and told her boss she heard him refusing treatment and being rude with her own ears. Her boss told her she would refund our copay.
    It is bad enough we are in pain for years, then to be treated like that is enough to push people like me over the edge. I cried hysterically for hours, wanting to die. The pain lasted all that night and the next day and night. By friday morning, I was so sick I could barely stand, it had caused the worst migraine of my life. He took me to the ER at Sacred Heart hospital. They treated me right away, giving me injections of dilaudid and zofran. When she checked back in, asked if the pain was gone, i told her no, still laying there with a towel over my face, she gave me another injection of dilaudid. This is the way we should be treated. I dont want to be like this, Ive done everything to try and get better but I am getting to the point of giving up. I dont feel there is any drs of quality in Pensacola.
    you are not alone, this is only one example of this treatment. My pm doctor just released me due to the fact I dont respond to steroid injections, the stimulator didnt work and the drug pump wont work so he doesnt want to treat me just pharmecutically.

    Old 05-02-2010, 08:41 PM   #8
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    Re: Injection and pain mgmt problem

    What I've done is report any other medications to the pain mangement doctor before they find out any other way. When I had my spine surgery I was discharged with a prescription for 2 weeks worth of pain meds. Upon getting home from my week in the hospital I called the PM doc and detailed what had been prescribed, by who, and that I had filled it as a 24 hour pharmacy as my normal pain medication pharmacy (I use one just for pain meds) is only open 8-6 M-F and I was discharged late one evening. I also wrote this down and faxed it to them.

    I've been in PM for a few years and a few years ago I tore some ligaments in my ankle and got a prescription from urgent care late on a Friday night which I had to fill since it was stronger than what I had from PM and my ankle was in bad shape. I did the same thing that time and notified PM of what occured, gave them contact info for the urgent care facility and even got a copy of the urgent care report to fax to my PM doctor.

    In both of these cases prescritions overlapped, were from different physicians, and were filled at different pharmacies (after the ankle we again had to go to a 24 hour pharmacy). So my PM doctor and his practice have been fine with this since I've notified them.

    My PCP offered to prescribe me Opana ER when he thought it would be a good choice and I should mention it to my PM doctor. I told him I was under a PM contract and he fully understood but offered to intervene in contacting the PM doctor if my pain was severe. I told him I would hold off until my PM appointment later that week.

    The key is informing your PCP you can only accept meds from PM and tell the PM if something happens that is urgent that required different medications. I even told my PM about the cortisone injection in my knee as it may show up on a urinalysis if they had requested one.
    Rt thumb fusion '13. R&L thumb arthroplasty '12 ; RT TKR & Bilat CTS' 11. Fusions: L5-S1('87), L4-S1('93), C5-C7('06), L3-S1('10), C4-C5('13). C5-C7 foraminotomy '08

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