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pcp verses pm

sadielynnssadielynn Posts: 15
edited 06/11/2012 - 8:39 AM in Pain Management
i wonder if i should be seeing a pm dr instead of my pcp,dr. my pcpc gives me my pain meds, but he doesnt really manage the pain, my bottle says must last 30 days, but its never enough, i dont take to many or abuse them, its just that i only have enough for about 5 hrs of the day, then iam in pain the rest of the day. would i need him to refer me to a pm dr, or try to find one myself ???


  • My Primary Dr. covers my meds also but I had to visit her frequently and let her know the meds only last less than 6 hours instead of the expected 12 hrs. and she's increased the amount 4 fold within the first few months of my injury. It would be good though to see an Orthosurgeon or Neurosurgeon first and then you get a referral to pain management for your condition. I hope you get some more pain relief soon. 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
  • In most cases you will need a referral from you PCP to see a PM. Depending on where you are and what type insurance or other care is offered in your area.

    It is not unusual for pcp and even pm docs to undertreat. They want to keep you on as low a dose as they can. There can be any number of reasons. Be sure if you do get a referral that the PM will handle pain meds, many do not. They only offer injections, SCS, Pain pumps and other "procedures". Also many PMs will not script meds on the first visit. They will often want to run tests, mris etc, before writing scripts.

    Yes, in answer to the unasked question.
    It can be a P.I.A....
  • your comments were very helpful, thanks i appreciate it
  • doctor may be able to offer so much more than just the meds. But you should also have an easier time with a PM prescribing your meds.

    Good luck.
  • dilaurodilauro ConnecticutPosts: 9,832
    I think this really boils down to doctor areas of focus. A Primary Care Physician is a generalist that covers almost every aspect of a person's health.

    The Pain Management doctor concentrates on your pain and ways to manage it.

    Both can prescribe medications and both can use Pain Contracts. I know some people (many times it depends on what area you live in) that stay with their PCP..

    For myself, my PCP realized that I should be handled by a specialist and my Physiatrist. They are rehabilitation physicians, medical doctors who are: Experts at diagnosing and treating pain. In many ways they can be considered Pain Management doctors, but they do a lot more.

    One aspect where my Physiatrist is a major plus is that she manages ALL of my medications. That includes any pain , nerve medications to high blood pressure and any OTC. She may not write the actual script, but she has copies of everything.

    But keep in mind a Pain Management doctor is not going to prescribe any more pain medications that a PCP. They will look at the entire situation to see what is the best way to handle and manage your pain.
    That could include a number of conservative treatments

    - Physical Therapy
    - Aqua Therapy
    - Ultrasound/Tens
    - Massage Therapy
    - Acupuncture
    - Spinal Injections
    - Referrals to Osteopathic doctors

    In some situations they may actually decrease the amount of pain medication you are on. They look at the total picture that will best fit you.

    Remember, pain medications are not designed to eliminate your pain. Too many people keep wanting more pain medications so they are pain free. That might never happen. Instead what many doctors look for is the The Blend as a way to manage pain
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • i was just sent to a physiatrist about 2 weeks ago, he wants me to have a bone scan, he said he cant really figure this out until i have one. i had never heard of this type of dr. before, he asked me how my pain meds were working for me, i told him not very well, he offered to up my ms contin 1 pill a day, i told him no, but now iam thinking i should have said yes, my pain is unbareable, iam only getting 2 15 mil a day right now, its not enough, it does very little. this new dr thinks i could have RDS/CRPS, but cant say for sure without the bone scan, iam a little nervous about the scan, because of the stuff they inject in you. any help from anyone thats had the scan would be great. thank you
  • its called RSD/CRPS sorry
  • As I was just reading through the posts I was thinking of writing to suggest you see a physiatrist. The technical name of the specialty is Doctor of Physical Medicine and Rehabilitation. This type of doctor works to get a patient back on his feet and back to his daily life and can offer various treatments excluding surgery. Some specialize in orthopedic cases. I think it would be a good place to start --

    I'm sorry, but I am not familiar with your situation -- have you had spine surgery?

    The new name for RSD is now CRPS which stands for Chronic Regional Pain Syndrome. Here is a fact sheet from the NIH:


    I'm sorry I cannot provide any details about a bone scan. That is one test I have missed so far.

    Wishing you good luck...
  • i read the article you sent, it sounds so much like what i have. i havent had surgery, at this point they havent been able to figure out whats wrong. my MRI came back fine on my back, spine has a little artheritis, but that was it. i have severe pain in lower back down my left leg, iam having some discoloration in the left leg too. its non stop pain, i guess i will have to do the bone scan, iam not to excited about it. thanks again
  • I had to have a bone scan and the worst part of it was waiting from the time they inject you to a couple of hours later when they do the scan. when they injected the dye I never felt a thing. I found it difficult to stand for so long in one part of the test but overall was uneventful. I hope everything goes well for you and make time for lunch while there. 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
  • that makes me feel a little better, i have been worried about the dye they inject, i have vertigo all the time, so i always worry if something might make me feel weird or dizzy, thats the main reason i have put this off, i need to get brave and have it done. charry, can you tell me a little more about it, like do u stand, lay, how long does it take ??? i dont think its inclosed like an MRI is it ??? any details would be great. thank you
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