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Confused with PM Doc

AnonymousUserAAnonymousUser Posts: 49,671
edited 06/11/2012 - 8:28 AM in Pain Management
Hello All,

Sorry I have posted my back problems, I will next time I sign in and update my profile. In Short I have had an L3-L4 fusion back 2001, I felt great for about a year. The DR that did the fusion did tell me all he did was give me the nerve back and I would have pain the rest of my life and that the disc above and below the fusion were not in great shape and might need fusing later, but ok enough not to fuse right then.
Now to my question, I have been with the same PM for 3 years, now he has changed his ways, I have been on Percocet for ever but he has given it to me for the past three years 10mg 4 times a day, plus a weak muscle pill. A year ago he came out with this contract, which I had no problem signing and have no problem taking UA's whenever he wants. I have never lost my pills and needed more. I have been a prefect patient if he said lets try injections in my back I took them, when said lets try radio freq I did, and have been doing both for 3 years which help a little with the Percocet I can get around and work most of the time. Now the confusing part I was told He is not a pill giver, he will give me Meds as long as I have injections, He told me when I am not getting treatments I have to go to my primary caregiver for pain meds. My PCM is confused he told me that why I sent you to the PM Doc so he can track you Narcs and only one Dr. gives them to you plus you signed a contract with him, so I cant legally give you Narcs. So I tell my PM Dr, what the PCM said and as long as I tell him that I am getting my drugs from my PCm We are Ok.
I have never asked for anything stronger then what I am on now. So what do I do if the PM Dr. wont give me anything for pain and my PCm won’t give me anything. I joked if they would send me to the Betty Ford clinic for the with drawls or do I go cold turkey, take it up with your PCM.
I was in 2 helicopter crashes while in the Army, I will retire in 1 month so I will have to try to explain all this to another PCM, What Fun, I'm looking forward to someone else looking at me as a drug seeker, what a life! Last thing he is pushing the pain pump really hard now, not looking forward to another possibly failed surgery. Thanks for letting me vent.



  • I have my PCP or family Dr. give me meds. The PM Dr. I only see part time. This is my 2nd pm Dr. The first one was trigger shot happy with me and I got another pm Dr. who diagnosed my facet joint athropy. And receved facet injections for that and feeling a little better. I told him the other Pm gave trigger shots and he said I needed the injection to facet 2 Inches deeper than trigger. A fresh new pair of eyes pm said it says right on your MRI facet joint arthropy that means you get facet shots not triggers. Anyway I didn't badmouth the 1st one but when I checked his previous history he had incidents. Anyway my Dr. said I can have him look after my meds and I say why I come here every month for meds and the insurance is in contact with her. Must be she's tired of seeing me. She's been my Dr for almost 20 years.I would look for another Dr. If you've been on percs for so long I can't understand I take a slow release med and hardly have BTP. I don't know about contracts as far as I know we don't use them here. Find another pm Dr. or new PCP it looks like he's getting ready to let you go anyway. Good luck. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • I didn’t say this in the first post, but in the Army you are lucky to see the PCM twice that is why they sent me to the PM Doc, The PM Doc still wants to see me, but just for pain pump install then refills or injection and med refills but in-between injection see my PCM which is in direct conflict with his contract., I am just confused on the change in his office practices. I think he may of had a JACO inspection and got a warning, because he has changed PA's and a lot of office people.
    As for the Percocet I was trying to stay as light as I could on pain meds and still work. Before the crashes I was 6'3" now I am 6'1" with a lot of DDD at many levels. and disc bulging

  • First let me say thank you for protecting our country. I am truly appreciative and grateful of those who serve our country. It is a shame that you can not get better care considering what you have given up for our country. My brother is in the army and sometimes doesn't get adequate care for injuries he got while serving. He was a Ranger to start and then served 2 tours in afghanistan while being a crew cheif captain. He blew his knee out on one of his jumps while in afghan. He also has a bad back due to military and bad genectics from both our mom and dad.

    I also have problems with my docs prescribing pain meds. My primary did at first then referred me to ortho who wouldn't but referred me to pain mgmt doc who did injections and pain meds for a little while during that time but then stopped so went back to primary who referred me to neurologist who wouldn't then back to primary and now I am waiting for appt for neurosurgeon. My primary will give me pain meds in between but I've had issues where ortho found out I got pain meds from primary previous to appt with him so then said they wouldn't give me any but my primary isn't comfortable with giving me pain meds either. I just keep getting the run around.

    I wish you the best of luck and feel free to pm me anytime you would like to vent, chat, have any questions or concerns or anything.
  • Hi Helo,

    Firstly, thank you for your service! To have survived 2 helo crashes... you must be destined for something great! As to your current crisis... don't know if this will help at all, but it seems to me that with this "contract", IF your PM changes how he prescribes meds, ask him to write a letter re the changes to your PCM. If your PCM has something in writing from your PM, that should allow your PCM to prescribe... i would think :/ . IF your PM does get uppity about it... just explain to him - the same way you did in your email - about the type of patient you've been - calm and cool - without blame - just put it to him and ask him to help you understand the changes you've noticed in his practice...

    Good luck in sorting it out!
    L4-L5 fusion 1998; ACDF C4-6 2008; DDD
  • It's hard to figure out what is going on behind closed doors. Things go smoothly for a long time and then it's flipped upside down. You've done everything right but events do transpire that are out of your control. Are you considering having the pump installed? My doctors think a neurostimulator or pump will be beneficial in my case. I don't understand what your PM doc is doing, but maybe he's switching from prescribing medicines to just performing injections and procedures. A lot of PM docs are doing this and don't want to write scripts anymore. You still need to have your pain treated and someone needs to step in and take care of that for you. Congratulations on your upcoming retirement and I hope you feel better soon.
  • if it is a greed issue. They make more $ with the injections and have less liability. I have undergone a similar issue with my PM. months ago he told me that I am an exemplary patient have done everything that he has asked and will continue to write my scripts as long as he is in practice. Now, he says the only way that he will write the scripts is if I get a rhizotomy every 12 months. I have been going to him for 4 years and lately every time I see him he contradicts himself. It is making me crazy. So, I went to new PM today and they are so unorganized that it is scary. He will write my scripts but also wants to do a RF Ablation and if that doesn't work an SCS. I am really wondering if it is just all about the money with these docs. Good luck to you and please keep us posted.
  • It cannot be a greed issue since the PM doc is military. Unfortunately all military hospitals and clinics freak out in the wake of Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) inspections. Regardless if they are doing things properly or not.

  • My current PM is known [ I can't say how I know this!] is known for pushing procedures. Many of them, No meds. They are actually NASTY should you call to even talk to anyone there about it! They tell you to call your PCP or go to the ER!
    Anyway, I went to a second opinion PM 2 hrs away, out of insurance coverage, took me 8 weeks to get it approved. The second opinon PM was VERY well versed on my case BEFORE I walked in the door. Discussed his reasons for a SCS trial upfront. I asked about nerve blocks etc, He said that in his opinion, for me. More injections or blocks or any other form of this type treatment would be short term. He said he would take over all forms of my treatment if I chose to change over to him. Alas, insurance, :O says no for now.
    Anyway, I expect that some PM docs are still dealing in all forms of care and do not have money motives. You just have to find them! For me, after the SCS??? If it doesn't work? Who knows where I turn for care? I'm beyond my PCPs level of knowledge now!
  • so far no problems with pm dr. another type of dr. you guys could try is a physiatrist, they handle pain mngnt. through meds. better living through better pharmacology. haha. good luck guys. must be real frustrating to have some one mess with what works. i heard of problems when dr.'s retire.
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