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1st Appt with pain managment doc

AnonymousUserAAnonymousUser Posts: 49,671
edited 06/11/2012 - 8:31 AM in Pain Management
I'll give you a brief history. I have had pain in my lower back and neck for some time. I went to spine doc and he said i have arthritis in spine and neck. He ordered a MRI and results were herniated disc c5/6. We decided on a shot in the neck for pain so I made an appointment (consultation) with Pain Management specialist on Thursday 6-11-09.

My question is: Do I tell the PM doc about the other pains that I have, for example, lower back, ankles, hips, knee, elbows, etc. I'm more concerned about my lowerback because as in my neck my lower back has constant chronic pain and acute pain once in a while where I am not able to bend even to put my pants on.

Does the PM doc order tests like MRI's and etc. to see why you have other pain? PM docs also prescribe pain meds? an a pain scale from 1 to 10 I think my pain in my neck (lol) is about a 6 everyday. I am constantly aware of it and just want to rest my head.

Thanks for reading and thanks in advance for replies. I don't have much to post to other members as I am new and I don't have much advice but I hope you'll be able to help with my questions. Thank you!


  • Hello -

    I think you'll be very glad that you've made the appointment with a PM Doc...doing so was the 1st step I'd made towards resolution of my pain/disability issues so I'm very glad that I did!

    Your PM Doc will ask you about ANY pain that you're living with, regardless of where it is and regardless of whether or not it might be directly related to your neck/back issues...so yes, you should certainly be completely forthright and inclusive in your replies to him/her about that!

    They'll order x-rays, MRI's, CAT scans, nerve conduction studies, myelograms and/or whatever else might be appropriate to best diagnose your conditions and yes...they certainly will prescribe meds for you that will lessen your pain and discomfort levels.

    My over-all advice to you is, to remember that PM Docs want you to work WITH them (versus against them), so have the right attitude in your appointment...and don't be demanding of them in any way, shape or form. Do let them know though, that you're counting on them to call the right shots for you, and that you're entrusting them with your situation completely...in other words, you're going to be more than happy to comply with what they suggest and subsequently order for you.

    Take care and best wishes to you -

  • Hi Jeff,

    Thank you for the reply. When I went to see spine-doc, the doc said PT is not a cure all so we decided on the shot and not going to PT at the moment. I know my body but I think they would know what is best for treatment for the pains and my back and neck issues.

    I wanted to know what to expect at the consultation and now I think I will be more at ease going to see him. I will go in with an open mind and I'm definately not a demanding person. I will ask for relief if need be.

    I'm 44 and don't want to feel old already. lol

    I give alot of hugs to all on this board and others who are in more pain than me living everyday.
  • It's good to hear that you're giving an ESI (Epidural Steroid Injection) a try because they definitely can offer some relief. I had one done at L4 back in 2001 and it worked wonderfully but conversely...I had one done in April of this year at C7 and it did absolutely nothing, and I just had an ACDF at that level (on June 1st).

    As for your pain, be sure to let him know how the pain is affecting your life...sleep, appetite, sex, work, play, etc., because that's ALL going to factor into the decisions he makes for you. He'll no doubt ask what you've been taking for pain relief and of course let him know, and then he'll ask how that's working for you...let him know that as well.

    Just go in with the attitude of "how can you help me Doc, cuz I'm counting on you to do so" and you'll be just fine.

    Best wishes on that and oh yes...I'm going on 47 next month and don't want to feel old already either, we just have to do our best to fight it! :)

  • Thanks so much for all your help. I have been dealing with the pain and some limitations for a couple years before I decided to go to spine doc. Family doc always said it was muscles and to go to PT and take Ibprofin. Ok. That was no help so decided to go to spine doc directly.

    Anyways, I really haven't done a lot with meds but ibprofin. Spine doc first gave me tramadol, which didn't work at all, then when I got the results for MRI from him, I told him about the tramadol not working and he asked me what worked for me. I said I have taken a vicodin for pain and it worked so he gave me a prescription for that. I know PM doctor will be more involved in it. I know it's a herniated disc c5/6 and arthritis but I don't know what's wrong with elbows, hips and other joints. Maybe now I"ll finally know.

    As i have read many times here, I don't want PM doc to think I am a drug seeker but without pain meds, I'm usually on sofa after work resting my head because my neck and shoulder area hurts from holding my head up. It is getting harder to keep house clean and lift things so I'm limiting myself on some things so I don't have after effects. I have 13 year old twins that keep me busy and a husband who is basically like a kid, lol, so I have 3 kids to take care of and 2 dogs and a house and work full time so this disc and associated pain does affect the quality of my life. I just want be able to go to PM doc with confidence and not be intimidated by him. I get nervous meeting new people. But, Jeff, I think with your replies I will be able to go and know what to expect at the consultation. I'm game for anything when it comes to healing my neck and other pains. The shot makes me nervous but if it helps no big deal. As long as when they give it to me I really don't care, which spine doc said they will medicate me for it.

    Thanks so much and I'll keep you updated.

    Ever since I turned 40 it's been downhill for me. lol I broke my leg and have a plate in it now a month after I turned 40. lol Then, gastritis, SIBO, IBS, you know, belly problems. Now this. I'm still greatful the rest of my body is healthy and I'm not going to let this get me down!!!

    Jeff, according to your signature you had surgery on June 1st? How are you feeling? I hope good and hope this surgery works for you!!

    Thanks again!
  • Once again, you're very welcome and thanks for asking about my surgery...I'm coming along nicely and as far as I know, I'm healing as I should be. The c-spine fusion has been a breeze compared to what the lumbar fusion put me through, there's really no comparison (pain or disability wise) between the two!

    Based on what you've posted, it sounds to me as though you might have either Rheumatoid or Osteoarthritis...both of which can attack your joints (more so the R.A.) and cause the pain you've described. Have you ever had a blood test for R.A. or O.A.??? If not, doing so might be something you should ask your PM Doc about.

    You'll do well with the PM Doc since you certainly seem to be a forthright person and that's what they look for, along with the fact the you've got your hands full at home with "three" kids like that. :)
    My wife and I have 5 children (ages 22 to 12), so I can certainly relate to your feeling as though there's no time to be ailing...and put it to the PM Doc just that way. If nothing else, doing so may serve to light a fire under his butt if he should ever think of procrastinating about your situation!

    Take care and thanks again, I'll be around on here to answer any other questions you might have or feel free to send me a "PM" should you need/want to.

  • Hi there,
    I agree with Jeff. You will do fine with the pain management doctor. I have been under the care of a fantastic pain doc. for about 4 years. I was sent to pain management after a failed fusion of c5-6. I have had injections many times and they all have helped but for only a few weeks. My pain doc. has installed an SCS and it covers up a good deal of my pain. I also have medication. Pain management has been a life saver for me! By all means, tell the doctor everywhere it hurts. At your first appointment you should be given a diagram to draw on. You can circle all the areas of pain. And yes, you need to be honest about all the areas of your life that are affected by your pain. You might have to sign a contract regarding the rules of pain meds. I am sure the doctor will give you medication. Good luck, you will do great!

  • Hi Melissa,

    Thank you for replying. I am going to write down things as they hurt so I don't forget. I tend to forget to say things at doc's office so if I right them then hopefully I'll remember them during the consultation. :)

    What's a SCS?

    I'm not worried about a contract. I'm only planning on taking what i need and that's it.

    Now I'm kind of looking forward to the appt. Maybe now I can feel a little bit normal now.

    Have a great one!!
  • Hi,

    I just wanted to drop a note and let you know that being honest with ALL the docs is the best way to go. Also, something i learned is that you should stick with the same pharmacy, (unless its an emergency)they then get a chance to know you and can stop you from taking anything that will interact with something else your taking (including OTC meds and vitamins). This saved my life literaly not long ago =D.

    I take 14 different meds and have full body pain, including migraines for almost 5 yrs now. I spoke with PM doc today about an internal stimulater (blocks the pain signals to the brain). I had been doing alot of research and thought i would throw it out there. I REALLY REALLY want off these meds but CANNOT function without them.

    Lots of medical things going on with me......too many to list, but i rate myself somewhat of an expert on the subject of pain, meds and quality of life.
    Keep in mind, that the PM is there to relieve your pain and increase the quality of life....Its what they do and what they are trained for. Its THEIR job to make you feel better, not yours. Make them work for it.....do your homework, (internet research) and dont be afaid to ask as many questions as you can remember at the time.LOL ;)

    If you like the doctor, get the nurses name.....it is usually easier to call the nurse for questions or concerns then the doc.

    GOOD LUCK you deserve as much relieve as you can get!

  • Hi,

    I have a paper to bring with me with questions and symptoms I wrote down to bring up with doc. This way I don't forget to mention it.

    I always use the same pharmacy so no problems there.

    I can't wait for tomorrow at 2:45pm. Right now I have no meds and my neck is screaming and I have to rest in on the back of my chair and my lower back and sciatica going down my leg is becoming unbearable to sit here at work. So this pain does affect my life - work, home, relationships. Right now I just want to go home and lay down but I need to work. I can't take time off. I think today I'm more concious of the pain because I want to be able to tell doc all the pains and how bad they are. Driving to work today i could feel the sciatica hurting to my knee. very uncomfortable. Enough of the whining. lolol

    Thanks to all and everyone please have a great day!!!!
  • I hope that your appt went well and that you are feeling better today :)))
  • I had my appt with the pain doc yesterday. He seems like a nice guy. I have two bulging, herniated discs. c3/4 and c5/6 with radiating pain down my right arm. Right now he just wants to deal with my neck. Does that sound right? Then we'll turn to my lower back and check that out.

    I have an appt on July 2 for an injection in my neck. Then a two week follow up.

    I still have some vidodin left from spine doc so those won't be up for renewal until June 21. He said stay on the vicodin as prescribed. Since my injection isn't until July 2 and script runs out before hand, do you think it's okay to call and have him refill it so I'll have relief until the injection. It's only 1 to 2 a day. (even though that's not enough). I don't want to be pushy.

    I really am hoping the shot works. I'm going to go back to my family doc and see if she can take an arthritis test cuz all my joints hurt also. I have to see her anyway to fill out my FMLA papers for work anyways so I might as well ask her that.

    Because of my insurance I don't have to get referrels so I told her I was going to a spine doc so I wanted to update her on that and let her know what's going on with my GI doc.

    This is very overwhelming to me at the moment. I have a family doc that was saying back and neck was just muscles and don't know whether to switch docs or not. And it seems like forever to get appts. with pain doc and MRI's and etc to get relief. I know it's not an overnight process but it is very frustrating.

    Well thank you for listening to me!!!!!!
  • Not sure, about your vicodin.

    If you have signed a pain contract with the PM then you will need to be very careful about calling for a refill. Since this was your first visit and he did not write the script maybe you can get away with calling for advice.

    Does your PM handle scripts for narcotics? Some don't. If yours does not then you will need to return to the doctor who wrote the script you have, or find one that will, which can be a royal pain in and of its own right! Been there, done that!

    Last ditch effort is the ER!

    Whatever you need to do, You should start working on it ASAP! It can take a while to get it figured out. Been there, done that to!

    In the future when you see your PM have ALL possible questions written down and DO NOT leave without asking them! In my case calling my PM to ask questions gets me little. They do not like to treat over the phone! In fact mine refuses and will tell me to go to my PCP or ER. Until I got that fact figured out I had some problems. Once I learned to call my PCP for my meds things got better.

    Make sure you figure out what all your PM is going to manage.
  • I would think it's okay to ask the PM doctor for the Vicodin refill since it will run out before the injection. Did you bring the bottle to the initial consult? That way he would know how much pills were left, and be comfortable in helping you out. Also you can tell him when it was last filled, and give him the pharmacy number so he can confirm. I really don't think it'd be a problem to get a refill.
  • I didn't bring the bottle, but the spine doc and the PM work in the same office so the PM has my records from the spine doc. I'm going to call when this script is done and see what happens.

    Go figure, we are concerning with my neck right now but yesterday I awoke in the morning and my lower back hurt so bad I couldn't put my pants on and it hurt all day. Today I woke up and my lower back is fine no acute pain just regular pain. Can't wait to have a MRI on my lower back.
  • Till the last day to call about that script!
    My doctors have always asked for at least 48-72 hours notice of the need for a refill.

    If you wait till the last minute and the doctor is out or the paperwork/your file is not someplace easy for them to find it, you may find yourself without med.

  • I am so glad you had a good appointment! Yes, Wrambler is right, call a few days before you run out. I would ask the PM because that is who you are being treated by now. Also, it is not uncommon to hurt a bit more after the injection. It always takes me a few days to start to get relief.

    Take it easy,
  • Thank you for your responses.

    The office I use I've used before when I broke my leg and had surgery. I've always called first thing in the AM and left a message and the script was ready by the afternoon. I wasn't seeing a PM, I was seeing the doc who did the surgery. I was just wondering which doc to call. I'll give the PM doc a call.

    I have to remember when I go for my follow up after the shot I get my exact results from my MRI for my neck. The spine doc said only one herniated disc, and the PM doc said two. I'm wondering what the report from the radiologist says.

    Anyways thanks for the reponses!
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