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    Old 11-15-2012, 04:37 PM   #1
    Pandie
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    Question New to Pain Management, worried about follow up appt

    Hi all,

    I'm new to Pain Management. After being on narcotics for over 10yrs, my new primary care physician referred me to a pain management clinic. I had my first appt a couple of weeks ago and things went well. The place looked a little shady, but the doctor was friendly and seemed to "hone in" on things other doctors have missed or completely ignored. He did an xray of my back and found a compression fracture in one of my thoracic vertebre. I had to have a hysterectomy before 30 and it's been a while now and I have Osteopenia (the precursor to Osteoporosis). My pain has been constant for 2 years.


    Because I've been on narcotics for so long, I've built up a huge tolerance. He gave me a prescription and talked about putting me on a "daily regime" of taking the meds. Long story short, I ran out early. Normally, I just suffer and deal with the pain in other ways until my primary care doctor writes another prescription, but new to pain management and have seen people talk about having to bring their bottles in for their pills to be counted, etc. I did sign a contract that I would come in for a urine test or pill count if the clinic asked, but so far, I haven't heard from them.

    I really want to try to do this the right way. The way that manages my pain. Do you think I'll be "dismissed" from the clinic if I tell them the truth? Should I just deal with the pain until I get another prescription and try something different to keep myself within the limit.

    This was my first try at a regime, but I totally screwed it up. Need advice. Thanks.

     
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    Old 11-15-2012, 06:21 PM   #2
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    Re: New to Pain Management, worried about follow up appt

    If you tell them you take more than prescribed, they will probably dismiss you. If they give you a urine test and your meds don't show up in your system, they will probably dismiss you. You are lucky to be in pain management and you need to decide if you want to continue to be in it. Taking only what has been prescribed to you and following your contract is the only way you will be able to continue having the benefits of pain management. In my opinion, it's way better having meds every day than possibly never having any again when you are suffering from chronic pain. Please think about it and if you can't control yourself, have a trusted friend/family member give you only what you're allowed each day. Once you're "red flagged" it's next to impossible to get any type of narcotic medicine. Even a great high isn't worth that. Good luck!!

     
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    Old 11-16-2012, 09:17 PM   #3
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    Re: New to Pain Management, worried about follow up appt

    More than anything else, be completely honest with your PCP. If you didn't follow the prescription exactly as specified, so say, and assure him/her that you want to follow the daily plan. Let your doctor know that you'll call for advice if things aren't going well and your pain isn't under control. I had a very bad month a few years back and took more pain narcs than directed. I was straight with my doctor, and he helped me so much. Often pain patients are dismissed because they don't come clean, either out of fear or being ashamed. By being totally honest, you'll develop a deep trust with your doctor and pain clinic, and that's really all they want. Good luck. I hope it turns out well for you.

     
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    Old 11-16-2012, 09:43 PM   #4
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    Re: New to Pain Management, worried about follow up appt

    Thanks so much Dave, very helpful. I do want to be honest with him. I've even thought of asking him to just write my prescription for two weeks at a time instead of a month. Still so new to him and the whole pm process, hard to know what to say or do... I know I need pain meds and just want to take them correctly so they will actually help me like they should. Thanks again!!

     
    Old 11-20-2012, 10:56 AM   #5
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    Re: New to Pain Management, worried about follow up appt

    In your initial post you said the place seemed "shady", I would check this Dr. out online, etc. Next, DON'T tell your Dr. to just give you two weeks worth, he will immediately think that you don't trust yourself!! If he is a decent Dr. he should give you enough (and the right med's) and be cautious of your well-being. Almost all PM practices are doing a "Pain Contract", it's basically to cover their practice and themselves. Really!!! I live in FL and with all the "Pill Mills" that were here, it has all PM practices paranoid. Best of luck!!!!

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    Old 11-20-2012, 01:04 PM   #6
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    Re: New to Pain Management, worried about follow up appt

    Thanks so much for the info. I've decided that I will have a friend hold my meds and I'll get them from her weekly. I'm just so tired of worrying about it, you know? I want help with my pain, but I'm so tired of what I feel like these meds are doing to my brain .

     
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    Old 11-21-2012, 12:09 PM   #7
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    Re: New to Pain Management, worried about follow up appt

    Dear pandie, welcome to healthboards! I think that this may help you to stay within the guidelines of the pain mgmt drs recommendations. When on short- acting meds you, meaning one,Go/goes to the bottle every 4-6 hours or however prescibed. I feel pain = get the bottle. When in pain mgmt, the main idea to put in your head @ home is the pain is going to be there but, if a 4-5 all day is better than a 2 then an 8. See, their goal isnt to make you pain free, but to make the pain managable by making it a 4 or 5 all day & night. Then you wont run out early. Take it as dr directed, by the clock. Not because you feel pain. Because thats what chronic pain is, all the time pain. Pain mgmt is to manage the pain to make it manageable all the time for you, not gone. Thank you, gmak

    Ps. Take like you are treating high blood pressure. You dont wait until your
    blood pressure is high,no. You take it everyday to control the high blood
    pressure before it goes up, to keep it from going up. Same for you, you take it to keep the pain from going up, before it goes up. And will your friend be able to protect that medicine like your life depends on it? Because there is no i lost them. If stolen, you must make police report. Even with this some/most drs will not replace it. Imo, if you are responsible enough to receive these meds, you have to be responsible enough to keep them & take them as instructed by the dr who is trusting you enough to prescribe them.

    Last edited by gmak; 11-21-2012 at 01:09 PM. Reason: ps, typos

     
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    Old 11-21-2012, 07:55 PM   #8
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    Re: New to Pain Management, worried about follow up appt

    Dear pandie, Gone are the days of i hurt & the dr gives you pain medicine. Imho, all the drs are afraid now to prescribe to the people that they have treated for years. Having pain mgmt is having your pain managed.There are hurting peopleevrywhere that want your app. When we let the pain control what we do, we would all run out early. But, you are being managed now & you must go by what the manager says in regards to when you take your medicine, the dr. Its different than what you are used to, just different. But, you will be so happy when you can do more things & feel more like your old self.The pain will be there, but if it is not managed then tell the manager, the dr.Please dont let this make you be nervous about it, its just a new concept to learn.Pain mgmt is better, in some ways & not in others, but the old way is gone now. So, this is what you have to do now. We all started off at the beginning just like you are now. I would be thankful that someone wants to treat us.I think that pain is hard on both the patient and the dr. I have faith that soon you will be on this board telling someone how, just like im telling you. Thank you for the thank you. Remember we are all in this together here, so post when you hurt or need some support. Or when you are doing well see if you can help somebody. Because we are all hurting here on this board. Thanks again, gmak

    Last edited by gmak; 12-05-2012 at 10:37 PM. Reason: typos, wording

     
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    Old 11-28-2012, 09:20 AM   #9
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    Re: New to Pain Management, worried about follow up appt

    Quote:
    Originally Posted by gmak View Post
    Dear pandie, Gone are the days of i hurt & the dr gives you pain medicine. All drs are afraid to prescribe to the people that they have treated for years. If your pain continues beyond a few months, a new area of medicine has opened up for them to use, pain mgmt. And it is huge. Pain clinics are everywhere because people with pain are everywhere. Having pain mgmt is having your pain managed. Like i said there are hurting people that want your appt. As long as you let the pain control what you do, we would all take them & run out early. But, you are being managed now & you go by what the manager says in regards to when you take your medicine, the dr. Its different than what you are used to, just different. But, you will be so happy when you can do more things & feel more like your old self.The pain will be there, but if it is not managed then tell the manager, the dr. Dont be nervous about it, its just a new concept to learn. But better, in some ways & not in others, but the old way is gone now. This is what you have to do now. We all started off at the beginning just like you. Be thankful that someone wants to treat us. Pain is hard on both the patient and the dr. I have faith that soon you will be on this board telling someone how, just like im telling you. Thank you for the thank you. Remember we are all in this together here, so post when you hurt or need some support. Or when you
    are doing well see if you can help somebody. Because we are all hurting here on this board. Thanks again, gmak
    Hello Everyone, I hope you all are doing well. I really just wanted to chime in to what gmak was saying. Gmak, I agree with you 100% and I feel the same way. I love this board, and the good thing about this board is that we are all pretty much going through the same problem. We are patients that are being treated or need to be treated for pain management. I have been a pain management patient for many of years. And I understand that in the beginning when my primary physician was treating my pain, it was different. First off, it was years ago, before the drug mills and all the prescription medicine abuse started becoming a big problem. I have an auto immune disease that is very debilitating to my body, tissues, and organs. So of course years ago, I was being prescribe what I like the call the babies in the pain medicine department...vicodin,tyl 3, etc. That was okay at that time. Due to the fact that I was so young (18-21). So as I got older the disease started to get worst. The hospital visits started happening a lot more frequently. With the disease attacking your tissues and organs, I started having other issues that would need different specialist, cardiologist,oncologist, neurologist, gastroetologist, and etc. (just to name a few). So of course things had to change as far as what they would prescribe for me and that also include the medicine that controlled my pain. There was times where I would have the meds but I wouldn't need to use as many as I they told me I could. Of course as things became worst and bigger problems started to arise they had to change things and I started taking the "junior" type of pain meds, Norco, and etc. In the last 6 years my disease really flared and became out of control due to the fact that I had became pregnant. (which is a no-no because how the disease attacks your organs it will cause more problems). So after being lucky and only being on restricted bedrest at 3 months pregnant, and going into premature labor at almost 8 months, things became even worst. After having my baby on the maternity floor, they put my baby in nicu, and they transferred me up 4 floors to the oncology icu. Due to the pregnancy and labor, my wbc was in the critical levels. Going through chemo, and having other issues the doctors had to give me stronger medicine. I would say after all was said and done, I ended up on social security disability, and I had graduated to "senior" pain meds. Of course by that time, the dea had changed so many things with the doctors about prescription medicine, and you heard more about people abusing the medications, and the doctors was treading on thin ice about it all. My physician had no problem prescribing me what he felt I needed but his thing was, my pain can be controlled better with a pain management physician. I understood and agreed. I knew he was nervous just like all the other doctors were about prescribing strong narcotics on a regular basis. He gave me a referral to a pain management doctor and by the time I started going to one I was taking "the big dogs" and it was almost like I was in a nightmare. The first pain doctor he referred me to took one look at me, (a the time I was around 24 maybe 25) and said, "your too young to be taking these meds". I am thinking to myself, "yeah, I felt the same way when I was diagnosed with this devastating disease after being in the hospital for months at the at the age of 14." I knew me and that doctor was going to have problems seeing that he never even looked at my records before running his mouth. Well after I told my primary about this and his comments, even though he was continuing my meds that I was on, my primary doctor didn't think it was a good idea to continue seeing him. He said that he even called my primary doctor asking so many questions about me. My primary said he had already assume negative things just because of my age. Well, after a few interviews with different pain doctors, I found one that I was alright with and my primary was alright with. I have been with him for a while now and he knows that this is not something I want. He knows these was the cards dealt to me. It is not my fault that I became ill at the age I did and I sshouldn't be punished or treated differently because of it. Sorry this is so long but what I am basically saying is with all of the health issues that I have had over the years and trust me I have had so much in between. Surgeries,biopsies, chemo, and hospitalized at least 6 times a year going back as longs as I can remember. And sometimes more than that. But when you start pain management, you have to remember the doctor don't know you. This is like starting a new relationship. In the begining you are getting to know each other. "Tell me about yourself" That is what the doctor is doing. He needs to know what brought you to them. After they get a understanding about your health and case then they start their own action plan of what they think will help.The trust has to be build. My pain doctor ended up changing most of my pain meds. At first I was taking oxycontin cr 80 mg twice a day (morning and night), then 60mg in the midday, for breakthrough pain percocet 10 mg every 4 to 6 hrs, then ambien cr at night because of really severe insomnia. On top of all that, plenty different therapies. Well after playing with the meds he finally put me on fentanyl patch 75mg every 48 hrs, he kept the percocet like it was and the ambien like it was. Like you said, I will never be pain free but I can get out the bed. I can do certain things. Of course I still can't work. I am on permanent disability. But at least I am not miserably in pain to where i can't do anything. I know that going to pain management physicians is very different from what you are use to but trust me when I say...when you find the right one, it is a true blessing. I went through alot trying to find the right one due to my age. Some didn't look into my records,didn't know anything that I had went through throughout the years but was quick to say I am too young. I have talked to so many people and seen so many that are not getting the proper pain management and they are miserable. It is like torture. and I will tell you that there will be times where your meds aren't touching the pain like you may want it to but what ever you do, don't take more. Take it like the physician prescribe it to you. Because you don't want to lose that trust with your physician and you absolutely don't want to be dismissed from the doctor. I have read on here so many times about people who said that because they were still in pain, they made a mistake by taking an extra pill maybe for a day or two. And because they ran out early they ended up getting caught up by the doctor and dismissed. Also, it is best to be honest with your doctor. Like I said you don't want to lose trust. But I will tell you, just because you come out and tell your doctor that you took more than you were supposed to doesn't mean that they will not dismiss you. I hate to say it but I don't know how many times I have read different people saying that they still was dismissed and now they are stuck. I personally just do everything by the book. And that is because I know what I have been through and I know how lucky I am to have a good pain management doctor. Yes you will still hurt, but it will not be anything like the torture you would go through with no pain management at all. In the day we live in today, it is very hard to find a pain management physician that is legit, and actually caring and wanting to work with you. It is so many that are very opinionated, and set in there ways, which means they do not listen to you (the patient) and even after they have made a mistake, they will not admit it. Some are so stubborn. I have heard so many stories about doctors who knew they were wrong but they will not admit it. If you have found you a good pain management doctor, you need to hold on to them with a death grip. I am very serious. If you think that you need a extra pill a day, you need to communicate that with them. Do not just take it. I know for a fact that if you did sign a pain contract that one of the things it says on there is that if you are not getting pain relief please contact the doctor. I know for a fact that if you do things the right way it will work itself out. When I first started with my pmp and I was having a bad week, I called to say that even after taking my bt meds I was still in bad pain. The nurse called back and told me the doctor said I can take a extra one a day if need to. And they changed my appointment date to an earlier one because he knew I would be out of meds earlier than expected. Not to mention when I did come to my appointment he changed my meds permanently to that extra one a day because it did seem to help. The point is like gmak said, whatever you do you don't want to mess around with your pain management. That is something that is very important and people take it for granted until you don't have it anymore. or you don't realize that you may not think your doctor is doing an adequate job because you are still hurting and then you leave them and end up with someone that is a whole lot worst. Thats the whole, "the grass always looks greener on the other side". If you are getting a good amount of relief....count your blessings. We all have pain. But is it tolerable is the question. Pain Management is to manage your pain. Not take it away. It the perfect world we all would have no pain at all. I hope that you understand what I am saying because I don't want you to lose a good thing. Keep me posted
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    Old 11-28-2012, 01:12 PM   #10
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    Re: New to Pain Management, worried about follow up appt

    I couldn't agree more, and I'd like to add to your thoughts. If you get involved with a pain clinic, it won't take long to get a feeling for their objectivity. If they bad-mouth your present course of treatment right off the bat, it's a good indication you're in the wrong place. Many PM clinics tend to take the position that it's a psychiatric issue, and they'll try to convince you that you can live with severe chronic pain if you just tell yourself it doesn't hurt. If they are anti-narcotics, you might be okay short-term, but the sad fact is most chronic pain patients will eventually end up on narcotics. Sooner or later, the lesser meds will be ineffective. This isn't to say that all patients will have to take strong narcs; some will do fine on the lower-class narcs. But it is always a possibility, and all concerned should be open to that. If they appear to not be truly listening to you, find someone else. I assess a doctor by how well he/she listens and absorbs what I'm saying. If you're being cut off mid-sentence all the time, he/she isn't concerned with hearing what you have to say. When you find a clinic that seems to actually be in tune with your condition and doesn't try to down-play it, (and you will find such a clinic) do everything you can to work with them. These are the clinics that actually help you manage your pain. It will likely take a combination of methods - lifestyle changes, behavior changes, medication and attitude. Meds are just one facet of the management. So long as you have an open, honest communication - both ways, and you work closely with the clinic to achieve your goal of keeping your pain down while living your life to the fullest, you'll do fine. Anything less in a clinic is, in my opinion, unacceptable.

    Last edited by dave490; 11-28-2012 at 01:14 PM. Reason: spelling

     
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    Old 11-28-2012, 02:22 PM   #11
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    Re: New to Pain Management, worried about follow up appt

    i agree and good luck

     
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    Old 11-29-2012, 08:52 AM   #12
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    Re: New to Pain Management, worried about follow up appt

    Thanks everyone. I'm getting ready now to go to my follow up appt. I went in on Monday for an MRI and Bone Density test and will hopefully get more info from those from my doctor. I am feeling at peace about my appt today. Thanks again for all of your help!! I'll update you soon. Hope everyone is having a nice day!!

     
    Old 11-29-2012, 12:16 PM   #13
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    Re: New to Pain Management, worried about follow up appt

    I am with the others on not telling him to prescribe just two weeks worth. Most doctors arent going to trust you if you dont trust yourself.
    I would be honest with him and tell him your medication isnt controlling your pain at the current dose. If you are going to run out early, it will not show up in a UA and he will know something is going on anyways. Tell him first so he doesnt assume you arent taking the pills.
    Sometimes it takes a few months to figure out what works best for you. I would also call him in the future if you feel like it is not working, before deciding on your own to take more. My PM dr told me if I needed more than my prescribed amount, I needed to call her or on the weekend go to the ER. They want to make the decisions on how your pain in controlled. Most of them are understanding as long as you are honest with them. There are a few that will dismiss for running out early but hopefully your dr isnt one of them.
    Good luck!!
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    Old 11-29-2012, 02:49 PM   #14
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    Re: New to Pain Management, worried about follow up appt

    Hi everyone, thanks so much for all of the great advice! I just got home from seeing my doctor. I feel so blessed to have this guy in my corner. He, and his staff, are amazing. For the first time in a LONG time, I believe they want to help me in anyway possible.

    We went over my test results that I had on Monday. I have Osteopenia (pre cursor to Osteoporosis), and along with the compression fracture in my thoracic vertebrae, I have 3 bulging discs as well between T7, T8 and T9. One of those is touching my spinal cord and he said we would just need to keep an eye on that for now. As for the Osteopenia, he is trying to find an IV or injectable medication that my insurance will cover. Because I had gastric bypass 2yrs ago, I cannot take Boniva or Fosamax which is what my doctor had me on prior to the bypass. Those meds are very hard on the tummy and he said there's too big of a chance that they could burn a hole in my "pouch" or esophagus.

    He wrote my Rx and when I told him I couldn't pay for it until next week, he gave me enough to get me through til then free of charge. He's also going to try to look up any discounts that I may be able to use.

    For the first time in a LONG time, I feel hopeful again. I've been praying so long for God to help me and believe those prayers are being answered everyday.

    Thanks all!! Hope you are having a nice day where ever you are .

    "Give thanks to the LORD, for He is great, He is worthy!"

     
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    Old 12-05-2012, 01:36 PM   #15
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    Re: New to Pain Management, worried about follow up appt

    Yay, I am so glad you found a good doctor! It is great to have a doctor that cares and wants to help you. To us people with chronic pain, it is a blessing for sure and one I am grateful for everyday. I wish you the best!
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