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First time seeing a pain man. doctor-how should I best choose one, what expectations should I have,

AnonymousUserAAnonymousUser Posts: 49,671
edited 06/11/2012 - 8:37 AM in Chronic Pain
I've had pain in my back and neck for almost 2 years now.
I am 34 years old. My internist has tried to manage the pain with Hydrocodone for just over a year now.
It's not doing the trick. The relief comes on slow and is not that effective. I've also tried a TENS unit and p.t.
My dr. agreed to refer me to an actual pain management specialist.
I opened the yellow pages and there's over 2 dozen to choose from. I want an excellent doctor, and I need help in how best to choose one.
I'm sure there are certain things to ask about, etc.
I know all 2 dozen or so in my city can't be created equal.
Also, what expectations should I have, from research I know that some aim for near total relief while others merely aim for partial relief. My internist says surgery is frowned on these days, as the result is often more harm than good.
To summarize, just looking for tips in choosing a really good doctor here, how to do that and what to ask for and what to expect. Thanks all!

I have an 'annular tear' in my lower lumbar along with
'desaturation' of the disk. When the pain from this rears it's head death seems like a nice option.
I also have a 'hermangioma' in my mid back that causes constant biting pain, especially when sitting at my desk, etc. I also have neck and shoulder pain, my doctor says is associated with the local nerves.


  • I have multiple tears and they are very painful. Your internist may know who the best in the area is so you may want to see who he has in mind. Other than that unless you know someone that has been to PM docs in your area it will be hard to tell who is best until you meet with them. One thing that I think would be important to ask is what type of treatment they offer. Some PM docs only offer injections as an option which may be worth trying but I would want a PM that is willing to prescribe pain meds if needed. Good luck and keep us posted.
  • Have you seen anyone else for a second opinion? I would think that an annular tear could be fixed, as my friends was. I had three tears, and had a two level fusion last Dec. Still waiting on outcome.
  • I did not choose a fusion because of the low success rate. I had an endoscopic microD and PLDD for the tear that was causing the most pain. I have met many folks with annular tears that surgeons do not want to do surgery for. I went through a few surgeons that did not want to do surgery at all. That is why I think that a PM doc may really be your best bet at this point. There are many procedures that they can try to give you relief. It is my belief that you should try all conservative treatments before ever considering surgery.
  • the first thing is take all test to the dr, mri's cat scans, x-rays etc.
    when approaching pain meds, be careful because pain drs look for certain quesitons and responses that will put up a red flag such as naisd's won't work and the only thing that works are narcotics. just mention what you have taken in the past and if it is or not effective. if they start you our on a regimin of narcotics, they will start out with ones that are not as strong as others. you might have to sign a pain contract. make sure you make all apts. if you miss and not show up, the dr might think you are in it for the meds. establish a relationship with dr and don't be confrontational and don't whine. just be honest and if this does not work, try another dr. it is like buying a car, you might need to try dr's until you get one that yo feel comfrontable with.don't be afraid of surgery if recommended. yes it is a crap shoot but it beats exercises and therapy. you might need an injection. try it and see if it helps. if not then discuss surgical options. there are all sorts of surgeries out there besides fusion and laminectomies. finally, he might recommend a discectomy which is uncomfortable at at best. if he does, then have one done. they inject dye into your disc to see the pain levels.
    good luck
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • Jay,
    It is always difficult know how to make an informed decision and this needs to be a collective process working with a pain specialist that provides you with what you are looking for, it is vital to keep your expectations realistic and achievable and we are all looking for some improvement for the pain that we endure, only you know what this is and the improvements you would be happy with. It may well be a compromise between the projected improvement and the reality of how things transpire, once you make the initial decision we all have to live with the outcome, that leap of faith is always emotion expectant and a lengthy process.

    Your symptoms are unique to you, the alternative is to do nothing and live with what you have now, not an realistic option, this process is more about you then them, if you go in positive and adaptable to change, open to new idea and keep those realistic objective at the forefront you will be doing the best you can for yourself.

    You have to have some faith in the person that is helping you and feel confident that together this can be improved, this process always carries some risk and that has to be measured against is getting worse over time or more restrictive.

    The origin of your current condition may well not be reversible only the doctor would be able to tell you that, with PM your best option at this time.

    Write all your question down and ask about the success of others with a similar condition to yours. Ask him what he would do in your situation and get a feel for how this relationship is going to work for you as an individual.

    Good luck, many here have been where you are now, we know how it feels.

  • I had a PD that put me on such a high dose of steroids that I developed Avascular Necrosis in both hips that required replacement of both joints. Be sure to learn about any medication your given and that your PD isn't taking his own product as mine was. He lost his license to practice behind it. IF narcotics are given, use the lowest dose that you gget relief from and the most important thing for me is not to expect to be pain free. Everybody has aches and pains and as long as I'm functional, all is good in lala land.

    So far I've had posterior and anterior cervical lam/diskectomies with one fusion and 3 lumbar lams w/diskectomies and a lumbar fusion. Then I had to have both hips replace within the same year. My meds are 10000 iu of Vitimen D 600 unit of Calcium - Paxil for the anxiety and 60mg of MScontin am and pm.
  • Stay away from the one way thinkers, shots and pumps that my advice for you. Because when it gets down to a few pills given you more relief than on $800 epd injection. Don't turn over your PM from your reg Doc until your sure about your new one. My Internist is very reluctant with me concerning and pain med care now that I am under the care of a nuro- surgeon. Though they did give me a Cilistone steroid for some leg cramping that I am having since the surgery.
    New Docs can be another "type of pain in the back if you catch my drift".

    Good Luck !
    C3-4-5 fusion 2005
    C-5-T-1 disk bulged
    L-4-5 bulge to the right, with Microdiscectomy, failed
    L5- Bi-Lateral bulge
    Pain in right foot -loss of feeling
    Left butt, hip and front thigh pain with bad shooting pain into inside ankle sometimes
  • What steroids were they if you don't mind me asking ?
    "high dose of steroids"
    C3-4-5 fusion 2005
    C-5-T-1 disk bulged
    L-4-5 bulge to the right, with Microdiscectomy, failed
    L5- Bi-Lateral bulge
    Pain in right foot -loss of feeling
    Left butt, hip and front thigh pain with bad shooting pain into inside ankle sometimes
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