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    Old 02-21-2013, 01:14 PM   #16
    backhurtz
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    Re: Venting about Drs. treatment

    Kittkat,
    The reason that doctors won't allow someone to just take short acting medications, only when they determine they "need them" is for several reasons...first, if you are being treated for a "chronic pain condition", then that implies that your pain is substantial enough that it interferes in your activities all of the time, not just some times. Secondly, there is no way to determine what the patient is doing with the meds if there is not a consistent dosing schedule in play. And there is no accurate way of making sure on the physician's part that the patient that is prescribed the meds are using them as they are supposed to. Another issue with short acting, versus long acting is the pain relief is far more consistent with long acting than short acting and there is somewhat less of a need to constantly increase the dosage when using long acting meds.
    If a patient who claims they have a chronic painful condition that interferes with their activities of daily living, how can taking meds on an inconsistent basis be necessary?Chronic pain is just that, chronic, 24/7/365- in some form, some days worse and some better but there is always an underlying level of pain that interferes with sleep, work , daily activities so using short acting meds is counter productive to manage that type of pain.
    Steroid injections can be very helpful for some patients and many doctors who are treating patients with chronic conditions expect to see that the patient is willing to at least give them a try before resorting to using oral pain medications. They are especially helpful in cases where inflammation plays a part in the condition, so while you may not want them, if I were you, I would at least try a series ( usually two or three injections) to see if you get any benefit, if not, then you have every right to refuse them from that point but at least you have shown the doctor that you are willing to at least try what he suggests.
    Injections done with fluroscopy ( live xray) seldom have any concerns about misplacing the needle near the spinal column since the injections are usually done near the foramen or the facet joint if that is where they believe the pain to be coming from..
    I think that while, yes, you may have a better idea about what has worked for you in the past, a new doctor is going to want you to follow his recommendations, and his treatment plan, especially if you are a new patient to him, and I'm sure that he will listen to what has and hasn't worked in the past for you, but ultimately, it is up to him to make a medical treatment plan based on his physical findings, standards of care for your condition, previous tests and results and his determination of your medical condition.
    Maybe instead of having a chronic pain condition that needs daily treatment, maybe it is a flare of up acute pain that you are having? And that might explain why some days you don't feel that you need a steady stream of medication?
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    Old 02-21-2013, 01:27 PM   #17
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    Re: Venting about Drs. treatment

    That was a great explanation backhurtz! So true and a great way to look and think of it. Cathy

     
    Old 02-21-2013, 02:45 PM   #18
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    Re: Venting about Drs. treatment

    Backhurtz, Maybe you did not read what I said before.... Yes, I have had Trigger Point injections 3 separate times from the Orthopedic Dr. They did NOTHING for me, that is when they scheduled the Epidural, for some reason after going home & thinking about it, I had a very strong reluctance to have that done & I canceled it. That is when he prescribed the muscle relaxers & Oxycodone. They did not want to treat me anymore with meds after that, I think some practices are in it for money by doing "procedures" only.
    Everyone deals with pain in different ways, you don't know what pain I have endured throughout my life time, & I say endured, because I NEVER took anything for my pain over 20 years! I could not move from it sometimes. Some people just choose not to medicate & I guess I have very strong pain tolerance, or I am just stupid, I don't know. I am going back to my PCP tomorrow & having a heart to heart with him hoping he will be able to treat me without a PM Dr. I want to have another MRI done, this time for my Thoracic & Lumbar spine. I had a Lumbar MRI done 25 years ago which showed Twisted Facet Joints, no wonder I couldn't move! I haven't really had that severe problem for quite a while now, just pain in my lower back probably from picking up my Grandson & too much work in general. The most consistent pain I am having is in my upper back, neck & shoulder area, it is pure torment anymore! I am not a young person anymore so maybe that is why I am having trouble dealing with the pain now. Age just does wonders for us!

     
    Old 02-21-2013, 04:27 PM   #19
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    Re: Venting about Drs. treatment

    Kittkatt,
    I did read the entire thread before I posted the first time, so I am aware that you have had trigger point injections but they are not the same thing as epidural steroid injections or facet joint injections, which are done in very specific areas of the spine to treat and reduce inflammation and to soothe the area with the steroids and lidocaine that is used in the injections. There are many different types of lumbar injections, each having a specific purpose and intent on the physician's part.
    Some pain management practices are in fact geared only toward "interventions" , and are commonly called interventional pain management. They do injections, insert spinal cord stimulators and pain pumps, along with radiofrequency ablations, and some other interventions. Most interventionalists do not prescribe medications, no matter what.
    Some pain management practices are geared toward the whole pain management program, including medications. But even those expect the patient to follow their treatment program unless there is a very good reason for not.
    I would highly recommend getting a new updated MRI of all of the spine, since your pain seems to be at all levels given what you have posted. As we age, our discs dry out, and while most often, this is not a cause of pain, in some, there may be other factors that may in fact cause pain along with the drying out of the discs. It may also be that you have some underlying stenosis in either the spinal canal or the foramens where the nerve roots exit, and may be having some bone overgrowth, but given what you have said about your facets, it may be there is some overgrowth in those areas which is causing your pain, and they may recommend a facet radiofrequency ablation which burns the nerves in the facet joints but provides great pain reilef for 6 months to a year or more.
    I still think that you should at least visit with a pain management doctor, get the MRI's and see what you are told about the results, and then talk to a pain management doctor about treating the pain and see what he /she recommends. Most PCP doctors will not prescribe opiates for the long term, no matter what, and they are not trained to treat long term pain conditions. There are many options out there to treat the pain you are , but you have to be open to looking into them.
    Good luck
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    Old 02-21-2013, 06:07 PM   #20
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    Re: Venting about Drs. treatment

    Thanks backhurtz, I will let you know what my PCP says tomorrow, he probably will recommend a PM Dr., he did before.

     
    Old 02-21-2013, 07:19 PM   #21
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    Re: Venting about Drs. treatment

    Hey Kitt,

    I wish you the best of luck at your appointment tomorrow. I hope that your pcp can either help you or find someone good for you to go to. Let's just hope they know someone that will work with you in a way that is comfortable.

    My pcp couldn't prescribe me anything stronger than dilaudid and unfortunately, the person she referred me to was one of the injection-happy ones. I'm sure the injections help some people - for me, not so much; they just increased my pain for about a week, and I was still in pain, with massive muscle spasms and nerve junk - just the way it was before the injections. Of course, I also found out that lidocaine does that to some people - I can have it on my skin, but when it's injected, my muscles freak out.

    I understand following the doctor's treatment plan to rule out options that don't work up to an extent. Reality is, you still need to follow your own heart and decide for yourself what you're willing to accept in your plan. The doctor may not like it and may not want to continue treatment, but the choice is still in your hands.

    I can honestly say that if I needed to find a new pain management doctor, I would refuse facet nerve blocks, epidurals and the like because I've tried each multiple times and the radiofrequency freaked me out - especially since my experience with the nerve blocks wasn't a positive one.

    Again, I hope that you find some sort of relief - I hope we all do I'm still working towards some sort of semi-happy medium, but I have faith I'll at least reduce my pain enough to keep me semi-sane!

    Hugs!

     
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    Old 02-21-2013, 09:09 PM   #22
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    Re: Venting about Drs. treatment

    kittkat-

    I tell you what my PM doctor says about these doctors who with-hold pain meds from patientd who would clearly benefit from it as far improving function and quality of daily life. "These are doctors who are ignorant about chronic pain and refuse to educate themselves and keep up with the everchanging scientific information regarding chronic pain and narcotic pain medications, they offer cookie cutter treatment to any patient who comes to them for relief/treatment of chronic pain; they simply don't know how to treat it so they brow beat the patient into feeling like a drug seeker and it is a damn shame."
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    Old 02-21-2013, 09:44 PM   #23
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    Re: Venting about Drs. treatment

    Wow, BB07 --

    That sums up my previous pain doctor in a nutshell! He never spent any time with me - even with my first appointment, the very first problem he found ended our consultation. He never even bothered to evaluate me further at that appointment or any appointment after. I liked him a *lot* as a person; about as nice as you can be.

    Unfortunately, I began to feel like his meal-ticket. I had more injections than I could count and they only made me miserable and in pain. I'm not afraid of needles (well .. except for epidurals when I was in labor and I have to admit my blood pressure was through the roof for my spinal tap) but I had hoped that he would at least try some sort of medication on me if I tried his treatment for a while (even if it was non-narcotic). Now, I don't ask for pain medication and never have because I don't want to be flagged. I will say that my nurse practitioner told me to ask him for help because she couldn't give me anything stronger. When I told her that I was ignored by his assistant and he didn't even stay in the room long enough for me to ask, she told me to grab him by the collar and tell him to give me something the next time I went in. Again, he disappeared .. and I fired him.

    I'm eternally thankful that my current Pain doc doesn't make me feel uncomfortable by making me ask for anything ... he tells me what he wants me to try in addition to the oxycodone and tizanidine and gives me the opportunity to ask questions. He doesn't blink an eye if I come back the next month and tell him something didn't work or made me sick (Gralise) or gave me nightmares (Nucynta). Thank God for small miracles!

     
    Old 02-22-2013, 04:44 PM   #24
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    Re: Venting about Drs. treatment

    Hi, & thanks Megon & BB, I am glad to know there are some people on my side, it is so hard to make some people & drs. understand how we feel.
    After my dr. visit today, I just want to throw up! I swear I walked out of there wanting to cry & feeling like a drug seeker. I thought by going in to my PCP (because he's always been such a nice guy with me)& being up front, telling him how I honestly feel that he would maybe understand & work with me, nope, he won't, says he doesn't do chronic pain mangement & that he told me that last summer, that's why he suggested a PM Dr. I tried to explain why I didn't feel comfortable going there, because I DON'T want to be medicated all day long. He says "well they don't do that, they aim to bring you down on your dose of meds", I said "What?, all I've read on these boards, is how most people are put on INCREASING dosages, some so high I can't imagine how they even function" He must be in a damn dream world or just chooses not to see what is happening out there, because I truly believe that A LOT of people are made addicts by their Drs.! I don't want to be one of those people, so I choose to medicate on my terms, & I know what I can handle. His story is that when he was practicing in another town they had problems with people selling their meds & the office came under investigation so he chose not to put himself in that situation anymore by not treating "chronic pain", well, gee thanks!! I truly do understand how he feels & told him so but, come on don't take it out on those of us that really only want to feel better, not drugged! I will give him thanks, because he did renew my prescription this time, but no more, again, GEE THANKS! So bottom line it's off to PM for me....maybe.
    Sorry this is so long

     
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    Old 02-22-2013, 05:03 PM   #25
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    Re: Venting about Drs. treatment

    Awww Kat

    I have been in your shoes more times than I care to count! It's situations like the above that make you not want to seek out a new doctor and put yourself out there to feel belittled, even if that's not the intent of the doctor; it's how we make ourselves feel for wanting just 5 minutes of relief!

    Even with a great pain doc (who was willing to call me on a Friday night at 6:30 because of my concerns about Celebrex), I get nervous the days leading up to seeing him because I wonder if I took too many of my oxycodone (will he think I'm addicted) or because I didn't take enough (will he lower the number he gives me ... which is low as it is because he doesn't think I need them?). I shouldn't get nervous about it, but I do because I don't want to be seen as a pill-seeker, and I don't want to seem as though I'm not following his other instructions (the SI belt he recommended for when I'm standing .. as if I do a whole lot of that . I do walk out of there feeling better because he does the thorough exam and he knows I screech when he tries to lift my right leg or cross my right leg over the left (indian style), but don't react when he does the other side. I also know that compared to a lot of people within his practice, I hardly take anything for the pain.

    My problem is completely in my own head because of how previous doctors made me feel. I've never asked for pain medications, but I'm honest about all of the different anti-inflammatories and muscle-relaxers I've been on and about the few narcotics that have been given to me in the past (it's very difficult to get anything for pain around here, even post-surgery, they're very, very conservative). I can't help it if I don't "get" the euphoric high from any narcotic - I don't know what it feels like, and I can't help if my body breaks the medication down in such a way that I get no relief from them - so asking for something stronger than a percocet has always been out of the question for me. I've turned down my doctors in the past when they've offered them because they didn't work. Why spend the money or put the junk in my system?

    That being said, my pain doctor is very interested in lowering my dose/amount needed in a given month. He wants to find something that helps me day-to-day that won't affect my quality of life. He hesitated to add a second pill of tizanidine to my daily regimen because he didn't want me to be sleepy all the time. I appreciate it more than I can express properly, but I'm also glad that his first concern is giving me some of my life back - even if it means taking pills forever.

    I really wish you lived closer and I could refer you to my PM doc because you deserve to have pain-free moments in your life, even if they are few and far between. And more importantly, you deserve to feel human and respected despite your pain and disabilities. I just hope that by seeking out a new PM doc and not settling for anything less than what you want in a doctor/patient relationship that you will find the right doctor for you.

    All the best

     
    Old 02-23-2013, 02:10 PM   #26
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    Re: Venting about Drs. treatment

    Kitt,
    I know that you feel defeated but seriously, give a PM doctor a chance. You may find one that understands why you feel the way you do, and is willing to work his treatment plan so that you get both relief of the pain, in the short term but also is willing to work with you to find long term relief as well. They are not mutually exclusive and it doesn't have to include medications to the point where you can't function. IN fact, if it does, then he is not the right doctor for you either.
    Most PM doctors want their patients to be able to function in their activities of daily living, work ,personal family obligations and functions and to attend to their daily needs...and yes, using less medication but longer lasting allows patients to do that..so do injections and other therapies, swimming, excercises, topical meds, all work together to bring down the pain levels, to allow you to function at your best..
    I think that we all understand your fears, and yes there have been doctors who should not have prescribed high amounts of meds for some patients, but most PM doctors don't do that- the goal is to give you enough meds if they are warranted to allow you to function, but not enough to make you dopey or incoherant.
    The one thing you will need to remember going into this, is to give your body time to adjust to any new medication that he might suggest. It can take a few days to a few weeks for your body to become acclimated, but once it does, the drowsiness and other side effects that you may experience will disappear..and trying the long acting versions of medications , you may be very pleasantly surprised if the dose is correct , you still get consistent pain relief, none of the unpleasant ups and downs that come hand in hand with the short acting ones.
    I wish you the best.
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    Old 02-24-2013, 09:29 AM   #27
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    Re: Venting about Drs. treatment

    Dear kittkat, Ive read this whole thread & thought that this might help. I am a 4 laminectomy patient & chronic pain patient since my NS said the trigger points that he gave me for 17 yrs no longer could reach the problem, my pain was/is a true#10 sometimes & you can see why by looking @ my MRI. Pm dr started epidural injections & norco 10mg, neurontin & no matter that all of it stopped working he would not change a thing. Then i had severe allergy to neurontin or zonegran requiring hospitalization, my PM wouldnt even return my call so my gastro admitted me, called in NS, neurolo,internist, pm & himself. After seeing my MRI they collectively decided that a certain dr called Physical medicine & rehab dr,physiatrist, was the solution for me as their practice is 50% pain mgmt & 50% rehab & their key role is to restore functioning to the highest level that can be achieved for that patient. When i got to his office, I explained i did not want to
    feel drugged but wanted to just be normal. He explained to me that long acting narcotics do not make you tired, sleepy or drugged & all that i would feel is less pain so i could function in my life better. All of that has held true! He doesnt do epidurals, ablations, injections of any kind but over 12 years he has injected by my request my SI joint, elbow, etc by trigger point. One dr, one office, no urine tests, we have a very good trusting dr/patient relationship. After the first 3 years we found the perfect combo of meds, narcotic, muscle relaxers, lyrica that has remained @ the same dose for 9 years but last fall we did reduce it some. I thought that this might be a consideration for you to consider.

    Last edited by gmak; 03-09-2013 at 11:44 AM.

     
    Old 02-24-2013, 09:32 AM   #28
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    Re: Venting about Drs. treatment

    Dear kittkat, Ive read this whole thread & thought that this might help. I am a 4 laminectomy patient & chronic pain patient since my NS said the trigger points that he gave me for 17 yrs no longer could reach the problem, my pain was/is a true#10 sometimes & you can see why by looking @ my MRI. Pm dr started epidural injections & norco 10mg, neurontin & no matter that all of it stopped working he would not change a thing. Then i had severe allergy to neurontin or zonegran requiring hospitalization, my PM wouldnt even return my call co my gastro admitted me, called in NS, neurolo,internist, pm & himself. After seeing my MRI they collectively decided that a certain dr called Physical medicine & rehab dr,physiatrist, was the solution for me as their practice is 50% pain mgmt & 50% rehab & their key role is to restore functioning to the highest level that can be achieved for that patient. When i got to his office, I explained i did not want to
    feel drugged but wanted to just be normal. He explained to me that long acting narcotics do not make you tired, sleepy or drugged & all that i would feel is less pain so i could function in my life better. All of that has held true! He doesnt do epidurals, ablations, injections of any kind but over 12 years he has injected by my request my SI joint, elbow, etc by trigger point. One dr, one office, no urine tests, we have a very good trusting dr/patient relationship. After the first 3 years we found the perfect combo of meds, narcotic, muscle relaxers, lyrica that has remained @ the same dose for 9 years but last fall we did reduce it some. I thought that this might be a consideration for you to consider.

     
    Old 03-09-2013, 11:06 AM   #29
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    Question Re: Venting about Drs. treatment

    To everyone who has given me advice on my ailment, my PCP has referred me to a PM Dr. Who also does palliative care, when I first read what this was I thought "oh my, end of life care, they won't have time for my silly pain" but upon further research, I see that this also applies to people like me who have chronic pain. I think this is who I will see, do you think as this a good choice for me?

     
    Old 03-09-2013, 11:57 AM   #30
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    Re: Venting about Drs. treatment

    Quote:
    Originally Posted by kittkat View Post
    To everyone who has given me advice on my ailment, my PCP has referred me to a PM Dr. Who also does palliative care, when I first read what this was I thought "oh my, end of life care, they won't have time for my silly pain" but upon further research, I see that this also applies to people like me who have chronic pain. I think this is who I will see, do you think as this a good choice for me?
    Dear kittkat, If my pcp recommended him i would go but i would go like i was interviewing him, such as asking him after his exam, reviewing your tests ask him what eould he recommend if you became his patient. Im happier with physiatrist, a Physical medicine & rehab dr because his care & treatment is not onlu to relief pain like in a chronic or terminal disease but to establish better & better functioning in my daily life with no mention of epidurals or SCS or rf ablations but will refer if i wanted those things. I just want you to get relief & hope that the right dr for relief of your problems is found soon!

     
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