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Where do I go from here?

lilmamallilmama Posts: 61
edited 06/11/2012 - 8:39 AM in Pain Management
I've been in pain management for about two and a half months. Over these months, I've had 4 sets of injections all of which have worked, but not lasted longer than a week or so. My PM doc only does injections, pain med management (which I did sign a contract), and physical therapy. None of these seem to be really getting to the route cause of my pain. So I'm sitting here in not only pain in my lower lumbar area, but also up through my mid back, and neck. Since my surgery it seems that the rest of my spine is really in rough shape. I can't get into my PM doc until wednesday (which isn't even an appt. it's just a pick up of my monthly scripts since my doc is out of town for the holiday), and I'm nearly out of my meds. I just don't see this PM plan, really getting anywhere with treating and aleviating my pain. What in the world do I do? What do you do when the only treatments that your PM doc uses are not really working or going to treat the pain long term? I don't want to jepordize the realtionship and treatment that I'm currently receiving while trying to find another doctor, so...... how would you handle the situation?


  • I'm sorry for what you are going through and can sense your frustration. I'm having the same issue with my pain mgmt doc. She seems to have no game plan or long term goals for me. She asks me my pain levels and prescribes meds each month. If I think I need a change in pain meds or to try other things cuz I've done the research for myself, I have to speak up. I'm the one who suggested a tens unit to help with muscle spasms. I also brought up the idea of an ESI since this is the only injection I haven't tried yet.

    It must be extremely difficult to handle this with twin 3yr olds. My back pain began to get more severe when I was in my early 20's and I had my 2nd child at 23 which made the back pain even worse. Chasing him around for the next couple of years and lifting him and carrying him around only added to the situation.

    The best thing you can do is to do as much research as you can. You have to be your own advocate. I'm glad you find this site and it is very helpful with information as well as support. Feel free to PM me anytime for anything. Speak up and voice your concerns with your pain mgmt doc that you've addressed here. Honesty is the best policy as well as open communication.
  • I think you should tell her exactly what you wrote here...that the injections only last a week and that your current meds are not adequately controlling your pain. Let your doctor know how hard it is to do things at home on top of caring for your twins. Maybe she will add an ER medication to take with the Percocet for better pain relief. Take care
  • Just sending some support your way -- I can't imagine having your issues and having to care for twins -- I certainly hope you have help and support from family and friends.

    Take care,

  • If you did receive even short term relief from the injections it should indicate the precise area that your pain is coming from. Steroid injections are often used as a diagnostic tool to pinpoint where the pain is coming from. They may indicate that the pain is stemming from the facet joints which may indicate that a rhizotomy may help or they may indicate that you have nerve pain which may seem like an SCS would be worth a try. If nothing at all works and everything has been tried it sometimes comes down to requiring pain meds to help take the edge off and make it so that you can function. If your current meds are not helping it is time to talk to him about making changes in the meds. Most of us are able to find at least some relief from the right meds or combo of meds. It is not something that anyone hopes for but is sometimes necessary in order to have any quality of life. I hope that you are able to find some relief soon and please keep us posted.
  • I hurt my neck pretty bad the other day and I've called my Dr. trying to get in touch with him before this weekend (he's out of town all next week) and no call back. I had a 30 day supply of meds and today is day 30. They told me that they would have my refills for me on Wednesday and to wait until Dec. 28th for an actual appointment. I understand it's around the holidays but for crying out loud what do I do!?! I feel like I'm getting no where with this practice! I feel like I call weekly to push them to get me an appointment and treat me properly. It's to the point where I'm embarassed calling b/c I call so often, but I wouldn't have to if they just controlled my pain.

    Okay sorry, vent over.
  • They wrote you 30 day supply and it is done today, yet they aren't going to give you new scripts till next Wednesday? That just, well, you know.

    If they have done what I read, I would be either in the doctors office demanding the next scripts or on my way to the ER.

    Writing a 30 day script then telling you to come get new scripts in 35 days? Hello? that is just NUTS!
  • I don't get it either. I see my PM every month so I can get my script, and the front office schedules me so that I'll get in right before I run out of meds. I've never had a problem with refills and I always get to see a doctor every time I go. This shouldn't be happening to Lilmama.
  • Hello,
    For the most part PM manages the pain you have, it is not intended to be invasive, I had three epidurals they were intended to mask the pain and not eradicate its origin. Once all reasonable surgery has been utilised to its fullest extent, managing what is left, the pain is the only reasonable option then available. This is a question patients never ask and it is always thought they has a clear understanding of what is possible and what is not, when this is not always the case.

    Ask that question, will this process address the underlying reason for the pain or just the symptoms, many people enter Pm with the belief that this will get rid or improve the cause of the pain and for the most part it will not, we have passed that stage and at best this is about managing.

    A sustained collective approach is deem to be more effective in managing pain and your treatment has only been going for a short time, I know you had expectation of more improvement and it is disappointing when none of you reasonable expectation are being addressed. You should not feel pressured in asking for your meds that the process itself seems to be questionable and all your questions here are valid and proportionate. Most pm patients have had pain for some considerable time and jumped through many hoops before now to get here.

    Write your questions down.

    Every new stage is emotional and we do forget, we may have waited along time for this process to start and keen as we are to get on with it and find some negotiated solution we need to proceed with some care and methodically as you are doing. Building that trust and working relation ship is reciprocal and we need to be calm

    We had three young children when I had my op in 1990 so I know how the pace of change seems slow and you are doing a good job with all that responsibility at your age.

    Take care John
  • calling my PCP and told her what was going on. My PM doc is out of town for 1 1/2 weeks and his nurse told me "well if it's THAT bad then you should go to the ER or call your pcp; I can't give your refills until Wednesday so your going to have to just wait." Boy, don't they sounds like they really give a hoot. And, I have no idea why they are so set on Wednesday. I guess it's because that's when my next appt would have been. I usually have an appt every 30 days with them too, but since it's around Thanksgiving they told me they would just have me pick up my refills for this month and wait until December to have my next appointment. Anyways, I took the advice, and called my pcp told her what had happened. I was and still am in a lot of pain, due to whatever I did to my neck. She ordered an xray, mri and cbc count. She also gave me enough meds to make it until Wednesday. She thinks I strained it and there's a possiblity there might be a herniated disc or 2 given my symptoms.

    I think I'm through with this pain management doctor. I don't think I have unrealistic goals at all. I know I'm not going to be out of pain completely, but what I do expect is exactly what they practice, PAIN MANAGEMENT! What I have gathered in the few months I have been there is that they only do injections and pain meds. They don't address the real issue and work at fixing the real problem. At this point I'm unsure what type of doctor I should be seeing or who can help me keep my pain under control. I really feel like a lost puppy.
  • Pm is not surgery, and most if not all only do medication and injections, I notice you had a CAT scan and what was the outcome of that, perhaps your most recent mri will give a clearer picture of what treatment is appropriate that as you say pm is not helping for you. Even with good pm, the pain that is left may be unacceptable and many here live in that pain every day, having had surgery and it not being as successful that was initially predicted.

    Many here have tried the volume increase of medication route that perceived as the solution at the start equate to being more distant and dizzy all the time, living in that fog and functioning almost impossible.

    It was good that your pcp gave you the medication needed without question and supportive of your ongoing evaluation and condition.

    Take care John.

  • I'm glad your PCP was able to give you enough meds until Wed. Did you ask your PCP if there was another pain mgmt doc they could refer you too? I wouldn't want to go back to that place as they don't seem to care about the patient at all.

    Keep us posted on the results of your tests.
  • what a few people have already said here, definitely look into getting a new PM doc. Some of them have a "here's your pill, here's my bill" attitude about them. Until someone lives with chronic pain, they have no clue what it is like to just make it through each day. We are treated as just another number to process in 10 minutes and get on to the next patient. My PM is just OK, but very conservative and refuses to prescribe anything stronger than what he's already given me for the past 2 years. I'm stongly considering cutting ties with him and seeing someone new.

    Good luck. I hope you have success with getting your pain under control.
  • It is never easy living with pain and we all what adequate quality of life improvement, most of those who have gone down the increased medication route find that living in this zone of fog more problematic that the pain we endure every day. No amount of meds will relieve an underlying condition that may be best suited to a more invasive process, only mask the symptoms rather than the cause.

    I do understand Maddys sentiment of just providing the basics and in that we should expect more and request appropriate provision to the management of the pain that we have, this is an ongoing trial and error process and even after 20 years my GP is looking to seek an improving strategy for the pain that I endure all the time.

    Maddys perhaps you could ask why stronger medication is not suitable, conservative maybe another word for ineffectual and a more varied approach to any alternative medication available more suitable. Many decisions are made for our well being that we feel excludes us from knowledge of why this is preferable, one side communication is frustrating, we are all entitled to be informed of how and why these decision are made.

    Take care and good luck.

  • I so feel your pain!!! I have been through 2 PM doctors in the course of 5 years, the first one because I never saw the same doctor twice and the second doctor, well I screwed up but he was treating my pain so inadequately I did something dumb- smoked pot! I was not eating or sleeping, all of which was documented in my files for months!! I was eating one carton of yogurt a day, lost 20 pounds in one month! I would go in and my blood pressure would be 170/100, all due to distress from pain. I called in crying and wanting to kill myself and they said they could do nothing for me. They kept my meds at 4 percocet a day, no matter how much pain I was in. If I was placed on an ER med, they gave me additional muscle relaxers for breakthrough pain. He watched my reflexes in my arms fade to nonexistent but he said they were good enough for him. I never threw hissy fits or got upset with them, never showed drug seeking behavior which all of my doctors testified to at trial. I was stuck in a vicious pain cycle I could not break- I was even sent to a mental hospital for wanting to kill myself because the pain was so bad!! And the doctor did NOTHING! Because I was in a car accident, my choices were and are very limited. I have no health insurance, need a 3 level fusion but cannot afford one- I went to trial last year and won. I still have not seen a penny from the insurance company as they are appealing an 11-1 jury verdict and it is likely I will not have surgery for a few more years despite the fact that my discs are dying and turning black.

    But the point is losing my PM doctor has turned out to be a blessing in disguise! I went back to my pcp with my records and was up front and honest with him, something my old doctor never gave me a chance to do! My pcp was absolutely disgusted with my old PM doctor; my pcp was the first to treat me after the accident and was able to tell immediately how much I have deteriorated. R takes a whole body approach prescribing medicine but also encouraging vitamins and healthy lifestyle. Now I have my pain under much better control!! No more cycles and I feel more like a human again! I have signed a contract with him and am happy to do so. He actually listens to me and adjusts things accordingly- we have 30 minute talks whereas before I would have to grab the PM doc to get him to talk to me!! Yes, I am on stronger meds but I don't feel hazy at all- I am far less able to function when my pain levels are high than now!

    Anyways, sorry for the lengthy post but sweetie, please get yourself better care ASAP!! Find out about other PM doctors in your area, I believe there is a website that helps you to find doctors and some have even been rated by their patients!! I hope you find what you need!! Don't be like me and wind up in a 3 year cycle of hell!! Sending prayers your way!! Get the medical treatment you need and deserve!! You should not be treated like that by any physician!! Good luck!!
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