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Should I change PM Doc?

AnonymousUserAAnonymousUser Posts: 49,671
edited 06/11/2012 - 8:34 AM in Pain Management
Good Morning All!

Brief History. I have herniated disks c3/4 and c3/5. Had a shot recently and helped a little but by the end of the day my neck gets very painful with pain shooting down my right arm.

I have had lower back pain for a long time with pain shotting down both legs. Sometimes I can't even sit on the toilet to pee without tons of pain. I recently had a MRI on my lumbar spine and waiting to see PM doc on 8-7-09.

My question is - After my last visit he told me his practice does not prescribe pain medication. I'm there to see him to manage my pain and the shot worked a little but not where I can function normally without pain and restrictions. I have a house, kids, work fulltime, etc. I can't just lay down all day as many other people can't either. Should I switch pain management doctor? I'm trying the treatments but I still have pain and the relief to me is not acceptable.

When I see him on Friday, I will find out the results of my MRI on my lumbar. What do I say or how do I ask about pain medication again? I don't want to sound like I'm a pill seeker which I am not. I just want to be able to take care of my family the best I can and not be a lump because I am in pain.

Any advice will be appreciated!!! Thanks again!
have a great day.


  • as to changing drs i think it depends on the way you feel about his overall treatment. if you are happy working with him why not see your general practitioner for the pain meds and keep the pm dr for the rest of the pain management...
  • I went to my primary care for a follow up appt. with something else and asked her for a prescription and I told her the diagnosis from the spine doc and pain management and what I had done and she said since I was seeing the Pain Management doctor she didn't want anything to do with it. I'm thinking of changing my primary care doctor anyways before this because I don't think she me enough time or just blows any symptom off I have. For example, I had really bad heartburn, she says to be careful of what I eat. I go to a GI and have acid reflux and take meds for it and I had Small Intestinal Bacteria overgrowth and a couple other things going on. As for my pain in my neck and lower back she kept saying it was just muscles and to excerise them. Never once suggested doing an MRI or exray. I went myself to a spine doc and got answers. I have a name of a new physician that's taking new patients and hopefully I will feel comfortable and maybe this new doc will take the time with me.

    So far he is nice and we did the shot in my neck but I also feel he doesn't give you enough time and really doesn't listen. I'll have to see what happens on Friday when I see him about the results of my Lumbar MRI. This pain everyday is awful and having to work and etc takes a toll as you all know. I just want relief.

    Thanks for replying.
  • time to find new pm doc....like paul said ask up front to see if they provide meds....good luck
  • Since your PCP and your PM are both telling you they will not write scripts for pain meds I would think it is time to look for an all inclusive PM.

    They are still out there. You just need to ask if they take care of ALL ASPECTS of pain management.

    Be aware that even finding one may lead you in another direction.
  • I have trouble with the term drug seeker. I realize people use it for people who want drugs to get high or sell. Personally, I just want relief, and after years of suffering it doesn't matter if it comes from injections, implants, surgery, or pills. For me it's really been the combination of injections and pills. So a pain management doctor not prescribing pills would be like a doctor only willing to relieve half of my pain. I would not be afraid to switch Doctors for one willing to provide the treatments which will provide relief for you. This is all assuming you meet the requirements for long term opiate use.
  • Find a new PM anmd make sure that they will treat you with all methods necessary before going to your 1st appointment. Good luck.
  • I'd suggest that you make a point of explaining very clearly what your situation is, in regards to pain levels and coping with life.
    Ask him if he understands-put him under a bit of scrutiny to show that you are serious.
    If he doesn't offer a suitable treatment, tell him that you are not happy with him, that he doesn't really understand or care, and that you will be changing to another doctor.
    My first pain doc was actually a specialist anesthesiologist, and so was really keen on injections and such.
    My new one is a proper pain doctor, and promotes a holistic approach to pain management.
    Under this I have had much more success, with a remarkable improvement.
    This came from having regular remedial massages.
    So it shows that there are other approaches and attitudes out there that may be more useful to you.
    Not saying that massage will work for you, just that it pays to shop around for more caring doctors.
  • Thank you for all your replies,

    I have an appt. with PM on Wed. I'm going to see what he is going to do about this everyday pain in my lower lumbar spine that goes down my thighs. If nothing then I am going to swith docs. I need to be able to function and not be in so much pain all the time. I'm not a drug seeker which I feel the docs think you are. I just want relief. I'll see what happens on the 2nd.

    Thanks again
  • JJ - You can't just call up and ask if they prescribe pain meds, can you? I would think they would label me a drug seeker. Do you mean like from word of mouth and recommendations? I feel stupid in all of this. I get very nervous talking with any doc so I guess I have to be more aggresive and not so nervous with these docs and speak up at the appointments. If I want help then I need to speak up. I was just curious about how do you find out if they prescribe meds or not for pain in between treatments. I don't want to be on them the rest of my life but right now until we can fix it.

    Thanks you
  • You can ask what type of treatment they offer and if pain medication is one of the treatment options that they do offer. I don't think that should be a problem to ask at all. You may deal with some docs that initially suspect that you may be a drug seeker but once you develop a rapport with your doc there should be a mutual trust. Also remember you have plenty of diagnosed issues that explain where your pain is coming from. A compassionate doc will definitely understand why you need pain meds. Good luck and please keep us posted.
  • Another suggestion, which sounds like you have no control over at this point, is to have one doctor prescribing meds. Even though my GP is ultimately in control of my overall care, my PM is the only doc that I allow to prescribe me any meds. (Of course you may need to sign a pain contract which obligates you to the same thing -- I never had to do that.)

    I do not have to worry about drug interactions nearly as much. I've had some specialists taken aback when I tell them they need to call my PM, here is his card, and consult him. I'll pick up the script, if he thinks the meds are appropriate, at his office, thank you. If they have a problem, I'll ask my PM about the particular meds and ask if they would be good for me or why would the specialist want to prescribe them. He's great about answering those questions and even trying some of those meds occasionally.

    As you can guess, my family doc and PM doc are the best, I have the best relation with both of them. Good doctors make all the difference in the world. Shop around and tell them your concerns; ask questions and be completely up front with them. It can be time consuming and bring all of your MRI's and X-rays and anything else you can. If the doc is good, they'll address all your questions. I'm certain you will find a PM doc that will "step up to the plate" in your care!

    Good luck in your doctor hunt, I hope you are able to move forward in finding the source of your pain and in finding the right treatment for it!
  • Jay you are so lucky! I wish I could find good doctors who made me feel comfortable and protected. I like some of my doctors but a few make me uneasy. I think about changing and then I wonder if I am just searching for the answer I want.

    Of course I feel that way about alot of people in my life - lol.

    But seriously, if you aren't happy and can try another doctor(insurance allows) then go for it.
  • I have about 10 years of history with my present PCP. With that- I may not have agreed with all of his decisions, but the path to pain control was a conservative one. Logically- it made sense. I wanted to know what the problem was, not mask it with meds, until all options were exhausted.

    I have been to an Ortho surgeon, Spine guy, PT, Psyc and Pain Clinic, back care clinics and all.

    During this - I was also at ER about every 5-7 months where they assessed the pain and used narc and muscle relaxants to drop the pain levels.

    I pointed out to my PCP that I knew how to "fix myself". I just needed meds to control the acute pain and then I could go back to doing what I know is healthy for my back, exercise, PT and all the sutle things.
    I cycled -up through the 3 levels of the World-Health-Organ pain ladder meds and so when I arrived at the tier 1 meds - it was the next logical step.

    This did not happen in weeks - it was months to years for the whole process. And I did write my Pain Clinic and my PCP and detailed [11 pages] the last 3 years of care. And because no-one could come up with a Dx, but all agreed that the pain was real, I demanded treatment of the pain - in accordnce with the WHO and the Ontario guidlines for treating chronic pain. I gave my PCP a copy of them- so he could read them for himself. [Our Provinces codes and 15 years out of date]

    Today - I have been on meds for about 3.5 years and most of the time, they control things well. During a flare-up they are a little below what is needed, but I have lived with pain in the mid to high levels for awhile. I don't have to show up in the ER because I have meds to drop an acute episode and get myself back to a comfortable level. I am never pain free, but comfortable is my goal. At that level -I may ache and have all kinds of little things going on, but I am just fine, It does not distract my so much that my mind cannot focus on other things.

    Hope your better! Good luck looking for a good one.
  • Kris, it's pretty simple. Keep the good ones and forget the rest. If I'm uncomfortable with a doctor I will not go back to see him. The good ones will work with each other, that's how you build your "team"!
  • Thank you for your replies. I go today to see the PM. We'll see how it goes. After today I'll know whether to keep him or leave him.

    I'll let you know what happens.

  • Hi, Thanks again for all the replies. I made up my mind after my appointment on Friday. I'm going to change doctors. He was quick in the appointment and I don't think he was really listening to me. For my pain in my back and thighs, he wants me to use ben gay, PT which I'm going to which actually feels good as I going but really doesn't help much yet. I'm doing the excersises she tells me and still pain. Tells me to use the prescription antiinflamatories and that's about it. I had question about my hips and kind of just blew that off. So this afternoon I'm going to make an appt. with another doc.

    My question is. when I make the appt. does the new doc get the medical records or do i have to get them. I have never even got a mri report from the doc i was just seeing so i don't have anything but the actually mri pictures from my cervical spine.

    any help would be appreciated. Thank you. Have a great day. It's beautiful outside and I'd like to be out enjoying it but I have to be here and work. :(

    Thanks again
  • Hi Lisa,

    Best/fastest way is to fax over a request that BOTH you and the new MD are sent over the medical records (this should include the MRI interpretation from the MD & imaging center's radiologist) ASAP, also, be sure to bring the MRI films with you to the appointment. I'm a firm believer in having copies of medical records/tests in your possession to be able to supply as much info as possible to any new MD as well as avoiding unnecessary testing/procedures. I think you're making a good decision in seeing a new MD, I'd 'fire' the 1st doctor in a heartbeat if I experienced what you did.

    Good luck!
  • "Pain specialists" who don't prescribe medications shouldn't be allowed to practice as such. They seem to be more interested in doing procedures, which pay very well, than in treating the whole person.
    I have changed doctors in the past because they treated me as if I were a drug seeker, despite MRI evidence of severe stenosis. Thankfully my new PCP and pain specialist trust me, because my life would not be worth living without the pain meds. I now have severe lumbar stenosis as well as rheumatoid arthritis, so I have more pain in my future.
    Keep trying to find a good doctor until you're satisfied. Good luck!
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