I may not be the best person to respond to you lol Myself & my daughter have been to pain clinics and all the one we went does is the injections. Which both of us refused.

I at the time was only on Vicodin and the Dr got all up in my personal space and called me a druggie!

BUT I do know that there ARE good pain clinics out there and some members here have had a good out come from theirs.

Also you have been around the block a time or two So they may not play hard ball with you.

Please do update us what happens, your in my thoughts

I can't help you on what to expect.
But I would suggest going in prepared.
Type out your entire history including non-spine related stuff.
Treatments tried and how successful they were, what has helped and what hasn't. What things help relieve the pain ie. lying down, stretching, ice, sitting a certain way etc.
What day to day activities you can do and which ones you can't
Any medications you have had past and present and how well they work/ed.
Allergies
Make sure you take in all your scans and any reports you have from other doctors.
That way you'll ensure two things
1. you won't forget anything as is easy to do when in with the doctor
2. the doctor can read through it all and can get a "whole" picture of what you've been through and make a more educated strategy
Sometimes things get missed, because you didn't tell them something important or they didn't ask the right questions.
Any way that's my advice for what it's worth.
Good luck and I hope it all goes well for you.
Kylie

I think the hallmark of a good pain clinic and a good pain management doctor is that their first priority should be to, as best as possible, accurately identify the pain source.

I know your imaging studies show multiple possible pain sources, and most likely your pain doctor will want to do some diagnostic blocks or tests to try to figure out what is what. Imaging studies tend to show a lot of problems, but they may or may not actually be the cause of your pain. I know you are hesitant to do more injections, but they are probably worth while if they are being done for *diagnostic* purposes. You just want to make sure that the injections are not being done "just because they can." There are certainly pain doctors that like to chase pain with injections and use a "kitchen sink" approach where they offer up all sorts of injections just to see what works- not a good idea. It looks like with your history diagnostic injections are likely to be recommended because until they know what is causing your pain they are going to have a hard time treating it.

Another thing that may come up is a discogram. PM docs sometimes like to do this if they think the pain is coming from a certain disc. Again, it's a diagnostic test that may help give some direction to your pain treatment.

As far as meds, they should be able to help you figure out the most tolerable regimen. One specific drug you may want to ask about is baclofen. It is a muscle relaxer, but it is designed for long-term use. Flexeril is generally not recommended for long-term use, so that might be an option. I'm not very familiar with baclofen, but you may find it more tolerable than the flexeril because I know flexeril can be extremely sedating...

Good luck. PM docs have a lot to offer, especially once they have a good idea of what is causing the pain, so hopefully they will help you come up with some good pain control options.

Thanks for all of the info!

I just got all of my info and history typed out and put neatly into a binder last week when I went to get all my meds straightened out with my gp. So I should be fairly good to go with that with the exception of a few minor revisions.

And I am not against more injections or diagnostic testing but I got a little freaked out after the whole horrifying mess with my myleogram. Man that was a nightmare. I thought I was dying, seriously.

I have heard a lot of good things about this specific doctor I am going to so I really am hoping for a good experience.

This past weekend was my birthday, the big 30 and I pretty much spent all weekend in bed or lying on the couch miserable. I apparently went through my pain meds faster than I should have. So I go to have my next script filled and the Pharmacist informs me that he can not fill my script until Thursday of this week. UGH! I am out of pain meds totally. I am now realizing the Percocet is working somewhat, at least more than I had thought, which I guess is a good thing. I have not been without pain meds for a very long time and did not really realize how much pain I was in until now when I have nothing to even take the end off. And to top it off, I quit taking my Prozac last week! I am just out to get myself I guess..

Thank goodness my hubby tried to cheer me up for my bday, through tears, being depressed, and in pain.... He bought me roses, made me dinner, and drum roll please..... he did the dishes! Yep I was shocked It didn't take the pain away but it sure made me feel a little better.

We hear much too often from members that say that their current medications are not eliminating their pain. So what they do, as you detailed take more than the prescribed dosage.

Then when you go to fill a new script you find out that you will be rejected. The dosage levels for each medication are clear cut. They are documented in order to provide the patient with the recommended amount of medications. If you exceed that amount, the doctors and pharmacy may not offer to provide any assistance.

Patients have a explicit responsibility in taking their medications. The doctor writes the script and you must follow it.

Now, IF for any reason you find that it is not helping you, then you action is to discuss it with your doctor, not to increase the dosage.

Please remember that the pain medications are not designed to eliminate the pain. I hear all too often that a patient takes a narcotic and expects to be pain free. It is not that simple. Pain medications is just one part of a total package in helping patients manage and control their pain.

For your own sake, have a detailed discussion with your doctor, why you needed to take more than the prescribed amount. In dealing with the medical field for over 35 years now, I know that doctors will prescribed medications as needed.

Did you run out because you took more than scripted or because your doctor is like several doctors I know of, my PCP being one. They would write the script for taking X amount a day, then instead of giving you 30 days worth at that X amount they write the script for 25 days at X amount.
My PCP would always say, "Try not to take X amount every day" I told him if I did not need X amount I would not be taking it. Plain and simple, he told me to call when I ran out and he would give me a script for another 25 days. I went through this for over a year, very frustrating. Added $ to my co-pays and trips to the pharmacy. Yet he refused to budge.

I don't see any need to turn this into a big deal, I would simply do the math and ask your doctor if that is what is going on. If not, then you need to have the "this isn't working" conversation.

I am still fairly new to all of this. And great advice dilauro. I think my frame of mind is slowly but surely starting to change, as I do not expect to be pain free anymore, just a little more comfortable. I realize now I should not have taken more than what I was told and should have discussed with my doctor that it is no longer helping to control the pain.

And Wrambler, I made the dumb mistake of taking more than I was directed, on certain occasions when I was having an extra bad bad, instead of calling my doctor and dicussing it with him, which I have tried and they pretty much told me they do not know why I am in pain and will not try anything else, which is also why my original PM has sent me on to a new one (chronic pain doc at a pain clinic, not sure what the difference is between a PM and a chronic PM doc) and made it pretty clear that he is not going to do any more for me, as what he has done thus far has not helped what so ever. They were not even wanting to put me back on the Percocet. So instead of trying to call and talk to my old PM I thought I would take more and wait it out to see my new PM and discuss the fact that the meds are not helping anymore with the new PM doc. Not a bright idea apparently on my behalf. Live and learn! All of this pain management, pain meds, etc., are so complicated when you do not know the ins and outs of what to do and who to keep informed. Ugh!

Just be prepared to share all,and likewise be prepared to listen to his/her perspectives. You can't change the clinician's training, experience or perspectives on pain management. If they are different than what you believe you need, discuss the differences and be prepared to move on as needed, like you would with any other consumer service.

Happy Belated Birthday! Good luck with your PM Dr. appointment. I had enough of injections until I had more at my new 3rd PM Dr. last week and it's opened me up to see the injections have helped so far. Perhaps the Dr. could order a slow release medication that helps more than the Percocets. Wishing good vibes. Charry

Happy Birthday!

Don't beat yourself up, i've done the same thing. You do live and learn, especially when you run out and have nothing to take. I'm particularly careful now, so that I don't run out.
Kylie

The objective is to obtain a number of complementary products that do not work via the same pathways. Let your doctor discuss the product options. Consider acupuncture as well.

i use a pill box with my exact doses layed out for the week. I have the times I take the meds charted as well. I also chart the pain and then go over it with my doctor. We can clearly see what time of the day I have a lack of pain control and can adjust accordingly. One thing I might mention is some docs require you to bring the bottles in for pill counts. There is no way you want to be using more than is prescribed. They could call the day before and say bring your bottles with you tomorrow we are counting them, and I wouldn't try any of the I forgot my meds excuse or anything like that. You have to realize they have heard everything. For me it is just easier to be as open as i can, after all my doctor is there to help me and he doesn't like seeing me in so much pain. We have gone down on my meds as well with injections and what not and then the pain comes back we go back up. So just be very open with this new doctor. Every test they have given me the damage i have shows up so they know I am not fouling them with the level of pain I have. But I am also cautious they have offered me some much stronger meds and due to some family illness i declined. But you want to build a very strong relationship with the doctor prescribing you meds so he best knows how to help you. Good luck keep us posted.

I use one for my other meds. I am not quite sure why it has not occured to me to use it for my pain meds.... I am being much more careful now that this has happened. It is just so hard when I am waiting to see a new PM and the meds I am on are not helping that well. But more pain or not, I am only taking what the doc said and what is directed on the bottle and crossing my fingers this new PM will get this pain a little more undercontrol. I do not expect to be pain free but something has got to give a little. This is enough to drive someone insane. Day in and day out, pain, pain, and more pain!

Although we as patients may at some time feel the taking of more and more medication in the ultimate answer, as Ron said, the levels of medication are perceived as a indicator of you and not necessarily the pain itself, we are seen as the problem and in staying under the radar of those upper volumes of medication, the pain as it should be becomes the predominant issue. It may seem understandable that the pain itself should be easy to identify and for many this is not the case and the very reason we are attending the pain clinic in the first place. We feel that having identified the origin of the pain, a successful outcome would follow; this for many is not he case. The diversity of pain clinics modes of improvement are varied and although we might have expected them to be similar each one does it how they perceive is the best option.

Melzack and Wall the eminent pm doctors suggest a “multidimensional approach” to pain management has proved to be the most effective so perhaps we should look at additional procedures that may initially be unfamiliar. The important thing is to be receptive and adaptable and give it a go, it may work for you or may not, who is to know unless you try.

We all enter this process having lived with pain for some time and the expectation that it should have gone already and place high expectations on results, we are understandably sensitive to how this treatment is provided, our confidence or exuberance may have diminished over time and we should applaud every effort that we make.

My own PM residential consisted of a four week every day attendance, with doctor’s physiologist’s physiotherapists, we did most of this process in groups with others and discussed how living with pain and how to adapt to this lifestyle, they never said our pain would be eradicated or even reduced and some are sceptical of a none invasive process having any long lasting success. It eradicated the myth that others have to be in pain to understand us, those staff were the most professional and never questioned anyone’s integrity of the pain they endured everyday. They supported us with knowledge and understanding.

Finding that balance of when we are taking adequate medication for it to have some effect and not too much so that the side effects of the medication become more problematic than normality itself is always difficult, it is reasonable for anyone in pain to continue taking more and more medication in the belief that this is the answer, it brings up red flags to how we deal with pain. Not expecting to be pain free is a good if not unfortunate reality, so any improvement will seem like success.

Take care and good luck

John

the dr gives you x amount of pain meds to be taken x amount per day. People say but i am still in pain why can't i take more meds to help me? probably,pardon me for offending people, one of the worse , not dumbest, things one can do. first of all pain meds don't get rid of pain, you will always have pain even if you take 100 percocets a day. you will be dead, but you will still have pain. your dr is liable for your care and use of pain meds. if one takes more meds than needed and you die or get in a car wreck, the dr might be in trouble along with you. they are checked out by the dea constantly and it is very easy for them to get into trouble with prescribing these meds. one dr of mine had to take a seminar because a copy of a script was missing when the dea was auditing him. the dea looks at them as legalized drug dealers so by taking more meds than prescribed makes it hard for him and the rest of us who use narcotics and use them correctly. i have never had to take a blood test or have the dr count my pills because is use my meds the way they are supposed to be used. i had gall bladder surgery and i was in more pain, but i did not ask my dr for more meds. he said taking more meds would not help my increased pain level. one reaches a saturation point with narcotics and taking more won't help. so you take more, then what? you will need more when your body gets used to this amount, then you take more, then you get used to your new amount, i think you get the point. by using your logic, you will have to keep taking more and more with no end in site. if you have a problem, ask your dr, and if he says no, then so be it. bite the bullet and use what you have.
jon

No I get that the pain won't be gone but at the moment that was not quite the thought process I had. Lesson learned.

And to be honest the problem is that when I did call and talk to the nurse she would tell me to take additional meds to help. So I am not constantly taking additional meds, unless directed to. Too bad no one ever mentioned that if I ran out I would have to wait to get them refilled. This still seems to be learn as I go and am not perfect.

I see my new doc on Monday and am hoping he will guide me a little better with all of this pain management stuff then the last has. I am not stupid my any means but this is not something I have ever had to deal with and have made a mistake along the way and did not ask enough questions. Call me nieve I guess, or I just wasn't thinking. I in no way want to get anyone in trouble, docs included, or jepordize the rest who use narcotics correctly. One mistake does not make me a lifetime offender.

Like I said, lesson learned. I have stuck to, and will be continuing to stick to what I am directed to take and no more. Unfortunetly I feel like it is the blind leading the blind rigt now, which is why I have switched doctors. My last doc did not seem too interested in even attempting to help with my pain. He seemed to think spine issues are cut and dry. here have surgery and you will be perfectly back to "normal", problem solved, NOT.

This all just really sucks, plain and simple.

Yes, doctors should be controlling our pain, but some of what they say is true. If we are young, and they start jacking up the opiates now, we will develop resistance and there will be nothing for us when we get older.

The truth is, what they are not telling us because they don't want to depress us, that there aren't really a lot of good options. The way opiates work, they will be less and less effective the longer we use them. Shots only help some people and some disorders. All of the other meds- the antiseizure meds, the NSAIDS, etc., are very hit-and-miss.

And, of course, opiates are only moderately effective. We take one, it takes away 10% of the pain, we might think if we take another it will take away another 10%. But instead once they do what they can do they start making is sleepy and out of it, and then they start making us dependent. More opiates aren't always the answer either (right now, my vicodin isn't even doing 10%. Two tylenol does a better job).

I know this got long, clearly I've been thinking about this stuff. We want someone to make us feel better, but short of a morphine pump, which would not help us have more active lives, there aren't great options. I hope they continue research on these issues and keep developing new methods to help we of the bad back brigade to keep leading happy, active lives into old age!

One lortab 10 takes away 90 percent of my nerve pain and works on the arthritis burn too. That is why I don't understand the reasoning, that you have to have 100 percent pain for 2 hours in between.

One thing everyone needs to keep in mind is the insurance in this. Most insurance companies use outside firms to make sure the treatment matches the condition. Yes there are protocols for the drugs as well. I was just recently auditing some bills and found a really odd one, in the mess. It was a accident I got the copy. The insurance company paid to have my conditioned analyze to see if the condition matched the level of meds I am taking. Lots of your doctors own these programs as well. They put in the condition and out spits the answer as to what would work to control it. More and more doctors, hospitals and Insurance companies are going to these programs. It helps with errors and of course to keep cost down. All of our doctors are aware these systems are out there and they may never tell you they use them or they know they exist but they do. They also know if they prescribe outside the box they could put their practice up for examination by the feds. I kind of look at like I am running late for something I know I can speed but around the corner may or may not be a police officer do I take the chance or not. In my world no I don't like dealing with it period.

I have had surgery and meds increased for surgery and those extra meds taken away after surgery as they were treating the acute pain caused from surgery. But also while after surgery I was getting lots more rest than normal. But after so long I returned to my normal amount of rest.

using words like agony, so bad i cry , worse pain i have ever had, etc. all of these phrases some use smack like whining to a lot of pain dr's. yes i have had 4 major back operations, gall bladders stones and kidney stones, and all of these phrases sound like exaggerations to me. when i take my pain meds for these, i know that all of the pain won't go away. dr's hear this all of the time and react accordingly. i think a lot of pain drs. hear this all of the time and they think some are exaggerating their pain levels. this is why pain drs are sometimes difficult to deal with. they give meds to help pain and patiens come back and complain. pain dr's can't win for losing. once again by upping your meds you build a tolerance and it becomes a vicious cycle, still in pain and then you have used up all of your meds and then the dr won't give you more because you've gone over your limit
just my humble thoughts on the subject
jon

It's not like I am going to go in and have a nervous breakdown but at the same time from reading some of the posts I feel like I am going in to have a lie detector test. like I am going to be interrogated..

I have it all typed out and have kept a pain journal, as well as keeping track of good days and things that I have done that have helped/or hurt. Is this something doctors will normally review? I put lists of all meds I use or have used, history, list of doctors, surgeries, procedures done and what ones helped and didn't and what the effects were, if any, etc.

I have had worse pain, but I know it is going to go away. I had gallstones at 17 years old, had my gallbladder removed. That is the first time I ever even was given any type of pain med and when I left the hospital I never touched them again until I had all of this stuff with my neck.

I hope your Dr. makes you feel comfortable at the time and great idea to keep a pain journal. My PM Dr. didn't ask my pain levels as they do the injections usually first the next appointment usually and the next time you go they usually make you fill out a pain chart to see how the injections have helped. I know that many Drs like to give slow release narcotics as I started taking them right after my visit to ER when I first was injured and took Percocets. Then my Primary Dr. started me on slow release narcotics but I had to return frequently as the pain was too much for me and the break through pain was too much. I wish you all the best for your appointment and hope you get the treatment you deserve to be able to do the basic activities of daily life. Hopefully your Primary has sent all the necessary paperwork ahead of time. I hope this PM Dr. makes you feel comfortable at your appointment. Best wishes. Charry

Good luck with the appointment and please don't stress over one error. People here have been dealing with pain meds and the issues thereof for a very long time.
Obviously some just needed to vent and chose here to do it.
It's OK we all make mistakes, no-one is perfect.
You just focus on you and this new pain doctor. Between the two of you i'm sure you'll get something sorted out.
I urge people to re-read their post to check for the tone of what they are writing. Sometimes you can come of as angry bordering on aggressive and that doesn't help someone already in a fragile state.
I understand you have strong views, but perhaps just soften the blow and use less strong words to phrase it.
Have a pain free day everyone
Kylie

Thanks kylie, mouse, and charry it really has been a rough time here lately. Makes me think, do, and say things I normally wouldn't. I will let everyone know how my appointment goes. Usually I hope for a longer weekend but today I would be happy for Monday morning.

I hope for pain free days for everyone as well.

Have a great weekend.

Mel

No not at all happyHBmom! I appreciate the advice That is exactly what I was looking for. I rather receive advice going into it so I am more prepared this time and do not leave feeling like I did not cover things or forget to ask a question. I need the advice. That is why I posted.

I think my biggest problem has been that I had it in my head that the meds were going to take the pain away, which is not the right frame of mind to have. I feel like I am at least getting closer to realizing the fact that that will probably never be the case. I may be a little more comfortable but the pain is here to stay. I guess if they do figure out how to eliminate my pain, or any of ours, that will just be a bonus. Having the frame of mind that meds are not going to get rid of my pain in its entirety, is helping me to not take more meds than advised, less is more theory I guess.

I do not think it helps that I quit taking my anti-depressant a few weeks ago either. I have not really gotten over my brother passing away, even though it has been ten years, we were very close. Needless to say I feel myself going right back into being depressed and overly stressed and anxious, that and this pain is about to put me over the edge. Not to mention my job has been insanely busy.

Thanks all for your comments, advice, and well wishes, they are always appreciated. I think if it wasn't for coming here and posting my questions and concerns I would be lost. I have learned a lot since joining this forum. It has been very helpful.

Thanks again for everyones comments and support.

I am very happy with the new PM doc. He was awesome. He sat and talked to me for well over an hour, which was nice. I don't know that I have had a doctor sit down and talk with me quite that long. He really was concerned about me not having the right pain management, after looking at my MRI and all, he said he could not believe they were not trying to control my pain better. He also said the binder I gave him was extremely helpful. He said it normally takes him two hours to go over past, meds, treatments, etc., but I covered everything and he just wanted to go over how my treatment is going to work and the do's and dont's in pain management, which was so helpful. I even told him about the mess I got myself into running out of meds, he told me to be honest with him. He said he understood but if something he is doing to treat me is not working then I need to call him right away so we can make adjustments. He was so nice and imformative, and really seemed concerned for me, and he was really easy to talk to. He also said if he ever thinks anyone is misusing their meds he will be the first to be right in their face telling them about it he was pretty blunt as well and I like that.

He ended up taking me off the Percocet (he said I was on a baby dose for what I had going on) and put me on Fentanyl patches, Roxycodone for breakthrough pain, and Skeltalin for spasms/tightness, which I have not used yet because the pharmacy has not gotten it filled.

He said I have done everything I possibly can as far as alternative treatment goes and that my next step would be a pretty horrific sugery, he did not expand he just said that I would not want to have it unless I had to, last resort. I go to see the ortho spine specialist today so we will see what happens.

I am so happy it went well. We really seemed to click and I was comfortable talking with him, not intimidated at all. And so far the pain patch really seems to be helping. I still obviously have some pain but it is more tolerable then it has been in a long time.

That all sounds like great news and I surely hope it all goes well.

You might want to search out the threads on the patch as some placements seem to better than others for most people. I've never used it, so I don't have first hand experience.

Again, so glad to hear things went well.

Oh MelW I am SO SO happy for you!!!! I am THRILLED this app. went so well!

If you have any F patch questions please feel free to PM me - I was the queen at doing everything wrong with them when I first got them lol

Mel- YAY! I want your pain doctor, LOL!

I am so happy for you, how are you feeling today?

MsHumptyDumpty - I am swamped at work but as soon as I get a chance I will PM you for sure. I read every pamplet that was in the box and what the pharmacy gave me and still have questions. I have never used anything like this and it has me totally freaked out. But it is working fairly well and I can't believe it!

I so hope your daughter gets the same treatment soon. She sounds like she is in a pretty bad spot right now and I can not imagine. I think that is one of my biggest fears when I go to the doctor, them telling me they can't help me, which is why I ended up going to this pain clinic to begin with, last PM pretty much just said he can't help me. Oh I wish she could go to the doctor I went to!!!! I know he would help her. And he is not just about meds. He wants me to get to feeling better and then we are going to work on other, non med, treatments; more exercise (I used to exercise five days a week). He also said I could still be healing. He said it is not totally "normal" to take this long but it can take up to two years for me to heal, his wife had spine surgery and it took her a little over two years. So his goal is to continually review how I am doing. He did say there is no "cure" for what I have though. It is degeerative/arthritis and we can try to prevent it from getting worse but it is not going to go away.

Recovering from cervical surgery can result in "Adhesive Capsulitis" which has three defined stages: the painful stage, the adhesive stage and the recovery stage. Each stage last approx 4 mos. Some cases 11-35 mos have been reported & they are all very painful. AKA "Frozen Shoulder".