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Best Practice For Changing Pain Management Doctor

Fireblade-USMCFFireblade-USMC Posts: 14
edited 06/11/2012 - 7:39 AM in Chronic Pain

In 1994, I blew out L4-L5 and L5-S1. I have been fighting this every since that time.

I have had the same PM DR for the last five years. In general, the experience has been good with him until recently. However, we have gone through all the normal things that he can do to help me: spinal injections, double Spinal Fusion surgery, and spinal stimulator implant. We have done several years of PT, Lyrica & Neurotin, Celebrex, Muscle Relaxers and Opiates. Currently, I am on Opana 20mg twice a day which is doing nothing as I am on average a 7 on the Mankowski scale that grows to 8 at night.

Mankowski Scale 7
Makes it difficult to concentrate, interfears with sleep. You can still function with effort. Stronger Pain Killers are only partially effective.

I have also completed a Functional Capacity Exam where I was given a rating of in a 3 hour work day, I can sit and stand for 10 minutes with postural changes and walk minimum distances.

In the last two months, my PM has gone all dead fish on me. He switched me from Percocet to Opana ER and its doing nothing for me. Furthermore, I don't think he really believes me about the pain even though I keep a pain log and bring my wife to visits.

So the question is what is the best way to change PM Doctors? I hate to do it but if the guy has doubts about my honesty, has no plan, and isn't giving me enough medicine to reduce my pain, I am left with no other choice.

Feedback Requested


  • to hear that your having such a difficult time with your PM. I'm currently in a similar situation. I feel as though I am at a dead end with my PM. He does injections, and shovels out small amounts of pain meds and that's it. They don't want to hear from you otherwise. I feel as though they don't take my pain seriously or they just don't care.

    If I was you, I would either call or schedule an appointment with your current PM and sit down to discuss your pain levels and also mention that you just feel like your not being taken serious enough. Let them know that you are considering getting a second opinion. See if that doesn't light a fire under their _ _ _. If they care enough about you they will change their plan of action or treatment so that your not in so much pain. And if they don't then finding a new PM is definitely in order.
  • Just like any other specialist, I think PM docs get in a rut and tend to handle certain classifications of patients a set way. They often are not very imaginative. Mine decided that I should have a trial for a spinal cord stimulator. Perhaps he isn't used to having patients refuse a suggestion, but he didn't seem to know what to do when I told him I was not interested. HE looked at me and said "Then why are you here?" I told him I had been sitting there wondering the same thing. Needless to say, I have not been back.

    You may have to "interview" several new doctors before you find on you like...but, it sounds like a new pair of eyes might be helpful. Are you restricted to a military doctor or by insurance restrictions? If you are going to a PM whose background is anesthesiology you might want to look for a physiatrist...a "doctor of physical medicine and rehabilitation." They often have more tricks in their bag and approach a patient's issues from several different angles. Otherwise, unless you can get recommendations from friends, it is a matter of trying different docs until you find one you click with.

    Good luck. I hope you can find someone soon.
  • have you asked him why he has changed towards you? did you ever sign a contract? does he test your blood for opiates? there must be a reason why he is warm with you one day and cold the next? have you seen other doctors or gotten another prescription from another dr? if not, then get a new one. i know easier said then done. if he does ot answer your questions to your satisfaction, get a new dr.be honest with the new dr and tell him your problems you have had and you are willing to work with him and be honest with him
    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.
  • He does test me every month. I do not have a formal contract with him, but only get pain meds from him.

    I think I am just a less profitable patient since he can't think of any more procedures to do on me. Thats the best I can think.
  • Fireblade-USMC said:
    I think I am just a less profitable patient since he can't think of any more procedures to do on me. Thats the best I can think.
    That's exactly the way I feel my PM doc is looking at me too. He's given me 4 sets of injections over the past 2 months. None of which had given me relief for any longer than a week or so. Since he can't do any more to me for at least 6 months he's not going to make $$$ on me so I feel he's going to shove me under the carpet and forget about me. At least that's the way I've been treated over the past week or so when I called b/c I hurt my neck badly.

    I think the best way to deal with it is just like the others have said. "Interview" other PM docs until you find one that fits a treatment plan that works for you.

    Until I find a new PM doc, I am lucky enough to have my PCP that will provide my monthly scripts. I would suggest that you use your PCP or if you don't have that option then just play it cool with your current PM until you have found the right one, then cut ties. It sounds like your not going to get any further with your current PM and they really have no options to treat you with at their practice so I would move on.
  • I think that docs in general can lose interest in their patient but especially so when all of the $ making procedures have been tried and failed. Some just do not want to have the liability of writing script for pain meds unless they are able to continue with the $ making procedures.

    I had a PM doc tell me one time that he would not continue writing my scripts unless I were to have a "procedure" done at least once a year.

    I left him and went with another PM and the office staff were rude and very unorganized. I ended up going back to the original PM.

    I am in a small area and there are not that many choices for PM docs but if I do not get any relief from this procedure I will also be searching for a new PM.

    I have always had a good relationship with the one that I have but I will not continue to have invasive things done if they do not help.

    I think that a new set of eyes taking a look at your history can sometimes be good. A new doc may see things that your last one did not.

    You may or may not be able to interview PM docs. The area that I am in they will not even see you until you have been referred by another doc and then they look over your medical history and decide if they want to accept you as a patient or not. I could not believe that myself but it is true.

    Good luck and keep us posted.
  • Grey if I had a Dr tell me the quote below, I would report him to the state.

    "I had a PM doc tell me one time that he would not continue writing my scripts unless I were to have a "procedure" done at least once a year."

    I have had good relations with my current PM for five years, but in this economy its all about the $$$. If I am not spending $$$ doing procedures, then just writing scripts I am a liability. Most business would be downsizing me and that is my guess. I have done everything that the Mayo clinic defines as normal order, so there is nothing left to do on me.

    Whats killing me is that I am worse off now than what I was before the fusion and SSI. Now, I am not able to work, and will lose several million in stock grants. My PM even suggested that I accept going from a $125K job to a minimum wage job for 3 hours a day. My FCE said I could work 3 hours a day provided I didn't have to sit or stand for longer than 10 minutes. I honestly just sat in awe last week when he said this and denied my request to reevaluate my meds. He even refused to write a VA letter for me stating my condition in the meeting so I could get P & T. Then his office called and had a letter which was two sentences that was more contempt than helpful. I have never disrespected him or his staff and the letter was just plain disrespectful to me and did not serve the purpose at all.

    Has anyone else gotten to this point and experienced this? If they can't fix me, I really need to get my VA benefits in place.
  • I don't think it is just a $$ issue. I think doctors do not want to manage patients on long term narcotics. If you get to the point that narcotics are the only option, they want to be rid of you.

    I was with Kaiser when I had my accident, and the Kaiser doctors had no problems whatsoever giving me narcotics (Norco and then Vicodin). I had a shock coming out of Kaiser and finding out that I couldn't find a doctor who wouldn't flinch even at my daily tramadol.

    My current PM doctor is trying to get me to cut back meds, while I'd rather increase meds so I can get back to my daily activities. Every study I read says that people with chronic pain are unlikely to become addicted to lower dose narcotics. I understand the nervousness but if this is the treatment that will work for someone, they have to buck up and deal with it.
  • I would normally agree with you about that but there are other circumstances involved that I did not explain.

    My doc has no problem at all giving me whatever meds that it takes in order to control my pain so far. Although I am on fairly low doses because I can't tolerate the side effects.

    If I were you I would try and investigate what other options are out there for you. You may be jumping out of the pan and in to the proverbial fire.

    Good luck and let us know how you make out.
  • Thanks for the feedback. You are right about jumping from bad to worse possibility. I will definitly make sure I am cautious.
  • Greg, my heart goes out to you dude. You deserve to be treated with respect and I hope that there's another PM doctor in your area who will do so. I suspect that there's not much money in only dispensing meds.

    I"m new to a PM specialist and the guy hates answering questions which is a drag b/c I can profit from their perspective. Also, I"m under-medicated and the PA/NP treats me as a drug-seeker.

    Good luck. - m
  • It's a shame that we can't just get the help we need. Its bad enough being in chronic pain for whatever, but when you have to live with it and it when it can be fixed so easily, its just wrong.

    Good Luck
  • I'm sorry to read about your situation and it can be really hard to figure out what the best move would be. You're doing everything you can to communicate with your PM doctor but it seems like he isn't willing to work with you. Why, I don't know because you've been honest and diligent in tracking your pain patterns. It's hard to say what's going on with your doctor.

    If you do go looking for a new PM, they may want a referral and all medical records, along with current imaging like J.J. mentioned. My pain clinic agreed to take me on as a patient after my OS referred me over there. I hope that you find a doctor who is willing to listen to you and work with you to keep your pain under control. Take care
  • SpineAZSpineAZ WiscPosts: 1,084
    I had a relatively good Pain Management doctor. He'd do occasional injections and had no problem prescribing me the needed medications. He also had a very good bedside manner.

    In an annual physical with my primary care physician I mentioned the ongoing pain, new problems, etc. My PCP is the one who recommended Opana ER and said he had a new pain management practice he wanted me to try. I went in for an introductory appointment and did like the new practice. They prescribed Opana ER with vicodin for breakthrough pain and Soma as needed. I then sent a request to my prior pain management doctor for a copy of my file. My new pain management doctor did have me sign a form saying I was changing to his office for Pain Management and would not return to the prior PM doctor.

    Do you have another doctor you see who may be able to make a PM recommendation. I agree that if I didn't have a recommendation I might have been a bit scared to try and find a new pain management doctor thinking "what if this isn't an improvement"
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
  • I just went to a second PM Dr. when I asked my Primary to refer me to another one for a second opinion. When the Nurse called for another appointment I just said I wasn't going back to him anymore. I didn't like his remarks to me about it being to hard to get the epidural through "so much tissue" since I had gained an extra 35 lbs. because of inactivity. I'm scheduled for another Pain Management Center at a hospital because I thought I would benefit from Radio frequency ablation since the facet joint injections helped but the second PM Dr. didn't do those. I'm lucky to have my primary give me my meds also. I hope you find another opinion to see if that PM Dr. would be right for you.

    Do you think working and the increased activity is also causing you more pain? Best wishes for you on your decision take care. 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
  • you got to be a biker ?? with that name ??any way ..i am in the uk and whilst watching tv the other night i came across a program about American pain clinics ..OMG they are so different from the uk ones ..Florida ..was featured and i could not believe that one man could buy 3000 oxycodone pills in one WEEK !!! no wonder they call it hillbilly heroin ..what the hell is going on over there ..over here this is how we get our narcotics .first all our pain killers are from a script issued from our doctor {the family doctor} then we nominate a pharmacy to dispense the drugs so a tight control can be kept .i see my doctor ever 6 weeks and provided he is satisfied that i still require then medication i will get a script ..then i will take it to the pharmacy and get my pain killers .there is no way i could get extras .only in an emergency say i ran out over a back holiday then i would have to go to the emergency doctor and a small script would be issued .this would be followed up with a letter to my doctor and a phone call from my doctor to see why i needed the meds and maybe he would want me to go and see him to see if there was a problem ..again this is to make sure that i am only taking what i should be taking..i think that this is a safe /good way of getting my medication ..even before getting narcotics a patient would have to have had all the weaker pain killers and be seen by several medical people to ensure that the pain was real .when i started narcotics i did not understand what all the fuss was about ..i know now that i am on a desirable street drug and i know to take as directed and i understand the implications of misuse ..i hate being on them but as you all know i am in a lot of drug resistant pain ..i cant understand why healthy people would take this 5417 when there is nothing wrong with them ..i have never gotten high from narcotics all the DO for me is take the top note off the pain and make me constipated ! sorry to go off subject a bit but i am amazed at how different your system is compered to the one in the uk
  • You're process is the same as the majority of Americans undergo. That special is just an example of the abusers, users, and profiteers of the system.

  • One of the reasons doctors hate to prescribe narcotics here is that there is no way for them to know if you are going to different doctors and different pharmacies.

    I had to sign a form saying that I wasn't getting pain meds from any doctors other than my pm doc- but there is nothing to keep me from lying other than my conscience.
  • I'm in a somewhat similar situation, too. With only being able to stay in one position for 10 minutes and nothing seems to be helping or dulling.

    I've been feeling really frustrated with the help treatment (or lack of) that I've been getting and just made a post Angry with Medical Professionals in the Chronic Pain section. I had a dr that was outright offensive and demeaning, too. I switched to another after 2 years and she had interest when I first started with her, but now she is sick of seeing my face and even switches my appointments to her colleagues. I'm planning on changing doctors, again. I think it has more to do with losing interest in the case, than with money - my doctor is with social medicine so she doesn't get any perks for procedures I choose. It seems to be at the 2 year mark that I can't take it from them anymore. And they might be equally frustrated that nothing is working - and they actually have the option of ignoring the problem.
  • straker/uk? 3000 pills? Either rumor or a 'bad doc'. Which is why the DEA is clamping down on opiates in USA.
    This leaves me in bed with REAL pain, lost job/can't stand/sit-oh hell's bell's-it just hurts too much. I can't even get my kids clean gym-clothes!
    My doc wanted to put me (force) on not-affordable suboxone. Out of the blue, if I am an 'abuser'-it would be nice if my doc informed me!
    Have to interview new docs.
    /Car accident,scliosis,gynastcs injury, L-4,L-5, military neck/whiplash. Able to avoid surgery so far.
    I thought vets got lots of meds 'cause-well they are cheaper! Procedure/antidepressants: Docs. get lots (my last'shots'cost$$1178. +$148. One bottle of percocet-$30. and more relief.
    I am off all meds now&it is not a good thing-hope you find a better doc. &UK-in Montana we have the same rules as you do.
  • when you are undermedicated,and your Doc. has all These new DEA/FDA rules to adhere to or risk jail/court.Most likely, your med may be reduced-ouch!! I sure hope not!
  • clonidine,cymbalta-yes it is now all about the money. 'Diagnostic proceedures'-My bottom! I'v had this pain for 20 years! (I'm 50-3kids)
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