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Going to a pain clinic

MelWMMelW Posts: 427
edited 06/11/2012 - 8:42 AM in Chronic Pain
I go to the pain clinic on 3/15. Can anyone tell me what to expect? I am on percocet now and it just isn't cutting it anymore at all. Also, ever since my surgeon took me off my flexeril a few weeks ago I have been more miserable than normal. Is there something they can give me to help relax my muscles other than a muscle relaxer? Also, with the percocet not helping anymore, what is the next step as far as pain meds? I do not want to be doped up or loopy or anything but am desperate to get the pain undercontrol. U can see in my signature line what I have gone thru as far as treatments go, I.e. Injections, rhyzotomy, etc. Do they usually push more injections? I had 3 or 4 in bout 9 months, as well as the rhyzotomy and none of it helped.

Any insight will be greatly appreciated.


  • I may not be the best person to respond to you lol Myself & my daughter have been to pain clinics and all the one we went does is the injections. Which both of us refused.

    I at the time was only on Vicodin and the Dr got all up in my personal space and called me a druggie! :jawdrop:

    BUT I do know that there ARE good pain clinics out there and some members here have had a good out come from theirs.

    Also you have been around the block a time or two ;) So they may not play hard ball with you.

    Please do update us what happens, your in my thoughts :)

    L1 - S2 "gone" useless in 1 way or another. DDD. RA. Bone Spurs. Tons of nerve damage/issues. Stenosis. Both knees replaced. 50 yrs old. I had a great fall (hence my user name) at age 41 and it has been a domino effect every since.
  • I can't help you on what to expect.
    But I would suggest going in prepared.
    Type out your entire history including non-spine related stuff.
    Treatments tried and how successful they were, what has helped and what hasn't. What things help relieve the pain ie. lying down, stretching, ice, sitting a certain way etc.
    What day to day activities you can do and which ones you can't
    Any medications you have had past and present and how well they work/ed.
    Make sure you take in all your scans and any reports you have from other doctors.
    That way you'll ensure two things
    1. you won't forget anything as is easy to do when in with the doctor
    2. the doctor can read through it all and can get a "whole" picture of what you've been through and make a more educated strategy
    Sometimes things get missed, because you didn't tell them something important or they didn't ask the right questions.
    Any way that's my advice for what it's worth.
    Good luck and I hope it all goes well for you.
  • I think the hallmark of a good pain clinic and a good pain management doctor is that their first priority should be to, as best as possible, accurately identify the pain source.

    I know your imaging studies show multiple possible pain sources, and most likely your pain doctor will want to do some diagnostic blocks or tests to try to figure out what is what. Imaging studies tend to show a lot of problems, but they may or may not actually be the cause of your pain. I know you are hesitant to do more injections, but they are probably worth while if they are being done for *diagnostic* purposes. You just want to make sure that the injections are not being done "just because they can." There are certainly pain doctors that like to chase pain with injections and use a "kitchen sink" approach where they offer up all sorts of injections just to see what works- not a good idea. It looks like with your history diagnostic injections are likely to be recommended because until they know what is causing your pain they are going to have a hard time treating it.

    Another thing that may come up is a discogram. PM docs sometimes like to do this if they think the pain is coming from a certain disc. Again, it's a diagnostic test that may help give some direction to your pain treatment.

    As far as meds, they should be able to help you figure out the most tolerable regimen. One specific drug you may want to ask about is baclofen. It is a muscle relaxer, but it is designed for long-term use. Flexeril is generally not recommended for long-term use, so that might be an option. I'm not very familiar with baclofen, but you may find it more tolerable than the flexeril because I know flexeril can be extremely sedating...

    Good luck. PM docs have a lot to offer, especially once they have a good idea of what is causing the pain, so hopefully they will help you come up with some good pain control options.
  • Thanks for all of the info!

    I just got all of my info and history typed out and put neatly into a binder last week when I went to get all my meds straightened out with my gp. So I should be fairly good to go with that with the exception of a few minor revisions.

    And I am not against more injections or diagnostic testing but I got a little freaked out after the whole horrifying mess with my myleogram. Man that was a nightmare. I thought I was dying, seriously.

    I have heard a lot of good things about this specific doctor I am going to so I really am hoping for a good experience.

    This past weekend was my birthday, the big 30 :) and I pretty much spent all weekend in bed or lying on the couch miserable. :( I apparently went through my pain meds faster than I should have. So I go to have my next script filled and the Pharmacist informs me that he can not fill my script until Thursday of this week. UGH! I am out of pain meds totally. I am now realizing the Percocet is working somewhat, at least more than I had thought, which I guess is a good thing. I have not been without pain meds for a very long time and did not really realize how much pain I was in until now when I have nothing to even take the end off. And to top it off, I quit taking my Prozac last week! I am just out to get myself I guess.. ;-)

    Thank goodness my hubby tried to cheer me up for my bday, through tears, being depressed, and in pain.... He bought me roses, made me dinner, and drum roll please..... he did the dishes! Yep I was shocked :) It didn't take the pain away but it sure made me feel a little better.
  • dilaurodilauro ConnecticutPosts: 9,859
    We hear much too often from members that say that their current medications are not eliminating their pain. So what they do, as you detailed take more than the prescribed dosage.

    Then when you go to fill a new script you find out that you will be rejected. The dosage levels for each medication are clear cut. They are documented in order to provide the patient with the recommended amount of medications. If you exceed that amount, the doctors and pharmacy may not offer to provide any assistance.

    Patients have a explicit responsibility in taking their medications. The doctor writes the script and you must follow it.

    Now, IF for any reason you find that it is not helping you, then you action is to discuss it with your doctor, not to increase the dosage.

    Please remember that the pain medications are not designed to eliminate the pain. I hear all too often that a patient takes a narcotic and expects to be pain free. It is not that simple. Pain medications is just one part of a total package in helping patients manage and control their pain.

    For your own sake, have a detailed discussion with your doctor, why you needed to take more than the prescribed amount. In dealing with the medical field for over 35 years now, I know that doctors will prescribed medications as needed.
    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
  • Did you run out because you took more than scripted or because your doctor is like several doctors I know of, my PCP being one. They would write the script for taking X amount a day, then instead of giving you 30 days worth at that X amount they write the script for 25 days at X amount.
    My PCP would always say, "Try not to take X amount every day" I told him if I did not need X amount I would not be taking it. Plain and simple, he told me to call when I ran out and he would give me a script for another 25 days. I went through this for over a year, very frustrating. Added $ to my co-pays and trips to the pharmacy. Yet he refused to budge.

    I don't see any need to turn this into a big deal, I would simply do the math and ask your doctor if that is what is going on. If not, then you need to have the "this isn't working" conversation.
  • I am still fairly new to all of this. And great advice dilauro. I think my frame of mind is slowly but surely starting to change, as I do not expect to be pain free anymore, just a little more comfortable. I realize now I should not have taken more than what I was told and should have discussed with my doctor that it is no longer helping to control the pain.

    And Wrambler, I made the dumb mistake of taking more than I was directed, on certain occasions when I was having an extra bad bad, instead of calling my doctor and dicussing it with him, which I have tried and they pretty much told me they do not know why I am in pain and will not try anything else, which is also why my original PM has sent me on to a new one (chronic pain doc at a pain clinic, not sure what the difference is between a PM and a chronic PM doc) and made it pretty clear that he is not going to do any more for me, as what he has done thus far has not helped what so ever. They were not even wanting to put me back on the Percocet. So instead of trying to call and talk to my old PM I thought I would take more and wait it out to see my new PM and discuss the fact that the meds are not helping anymore with the new PM doc. Not a bright idea apparently on my behalf. Live and learn! All of this pain management, pain meds, etc., are so complicated when you do not know the ins and outs of what to do and who to keep informed. Ugh!
  • Just be prepared to share all,and likewise be prepared to listen to his/her perspectives. You can't change the clinician's training, experience or perspectives on pain management. If they are different than what you believe you need, discuss the differences and be prepared to move on as needed, like you would with any other consumer service.
  • Happy Belated Birthday! Good luck with your PM Dr. appointment. I had enough of injections until I had more at my new 3rd PM Dr. last week and it's opened me up to see the injections have helped so far. Perhaps the Dr. could order a slow release medication that helps more than the Percocets. Wishing good vibes. 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
  • Happy Birthday!

    Don't beat yourself up, i've done the same thing. You do live and learn, especially when you run out and have nothing to take. I'm particularly careful now, so that I don't run out.
  • There are 2 sides to that coin! I have done that myself, run out early. Sometimes my doc will see me early, sometimes she won't. Personally, I think doctors are way to stingy with the pain meds. I know I have 2 hours between the time it quits working entirely, and my next dose and it is excruciating! Sometimes it's worse because of stress or the weather, and sometimes not as bad and bearable. Sometimes, you are stuck with one doctor in your area that will even see a pain patient, and what they say is what it is - right or wrong. I think as long as you aren't going crazy, or your organs aren't suffereing any ill effects, why do they care if you'd prefer to be 80 percent out of pain most of the day as opposed to 80 percent out of pain for 18 hours, and in awful pain the other 6. It's a double edged sword in my mind... Sometimes you just cannot stand it for one more minute (especially if you have to work 40 hours a week)! Then, you say screw it, and take one an hour early, therin is where the trouble lies...
  • I couldn't agree with you more. This is the exact predicament I got myself into, having a bad day and take more and then before I know it I have ran out early. :( The problem I have right now is that my "old" PM doc has pretty much released me from his care and has recommended me to a "new" PM. He is giving me my meds until I get into this "new" PM but there was no way he was going to give me more or change meds at this point. It was like pulling teeth getting him to put me back on the Percocet to begin with and he knows I am in pain.

    And I do work 40 hours a week, minimum, usually it is about 45-50 hours a week. Sitting at this desk can really be excruciating. There are days I sit here in tears all day but can't leave because I have so much to do and if I leave I will just have to work a longer day the next. It is a vicious cycle. There are times I wish I could quit but I know I can't. My kids would suffer and I would rather be in pain then see that happen. We make a good living, but like I have said before, my check is what pays for my kids guitar lessons, wrestling clubs, meds (my oldest one is on three different meds a day, not to mention all of mine), and I carry the insurance. Health or happiness, what do you do???
  • Don't forget your old friends, tylenol and ibuprofen, when you run out of the big guns!

    It never ceases to amaze me that doctors parrot what they learned about addiction without using common sense. If a person is in pain, and there is a med available that will reduce the pain, the person is going to use it. It's not addiction, it's the body's normal response.

    Make sure to get some max strength NSAIDS when you are at the pain doctor, even if you can't use them regularly (I can't due to gastro effects). They come in handy for bad days.
  • The objective is to obtain a number of complementary products that do not work via the same pathways. Let your doctor discuss the product options. Consider acupuncture as well.
  • Sometimes even if you are having an unusually rough time and call the doc, they say tough. You still have to get up early and get yourself to work, put in 9 or 10 hours and come home and take care of the rest of your life. If someone throws a wrench in the mix, say your horse gets sick, he goes lame, needs veterinary care and you have to take him in, or your father ends up having cancer and has to be driven around, or your son gets in a car wreck and you have to deal with that - life isn't always a big fat bowl of roses and everyone has their issues. Doctors in my opinion need to be more tolerant and compassionate about such things, but in my experience - they are not. They don't care what your dealing with, just treat you like a number in a long line. When you live where I do, it isn't easy to find PM doctors either, so there isn't really an option of moving on to another, more understanding doctor. Sometimes it just flat out sucks.
  • i use a pill box with my exact doses layed out for the week. I have the times I take the meds charted as well. I also chart the pain and then go over it with my doctor. We can clearly see what time of the day I have a lack of pain control and can adjust accordingly. One thing I might mention is some docs require you to bring the bottles in for pill counts. There is no way you want to be using more than is prescribed. They could call the day before and say bring your bottles with you tomorrow we are counting them, and I wouldn't try any of the I forgot my meds excuse or anything like that. You have to realize they have heard everything. For me it is just easier to be as open as i can, after all my doctor is there to help me and he doesn't like seeing me in so much pain. We have gone down on my meds as well with injections and what not and then the pain comes back we go back up. So just be very open with this new doctor. Every test they have given me the damage i have shows up so they know I am not fouling them with the level of pain I have. But I am also cautious they have offered me some much stronger meds and due to some family illness i declined. But you want to build a very strong relationship with the doctor prescribing you meds so he best knows how to help you. Good luck keep us posted.
  • I use one for my other meds. I am not quite sure why it has not occured to me to use it for my pain meds.... I am being much more careful now that this has happened. It is just so hard when I am waiting to see a new PM and the meds I am on are not helping that well. But more pain or not, I am only taking what the doc said and what is directed on the bottle and crossing my fingers this new PM will get this pain a little more undercontrol. I do not expect to be pain free but something has got to give a little. This is enough to drive someone insane. Day in and day out, pain, pain, and more pain!
  • Although we as patients may at some time feel the taking of more and more medication in the ultimate answer, as Ron said, the levels of medication are perceived as a indicator of you and not necessarily the pain itself, we are seen as the problem and in staying under the radar of those upper volumes of medication, the pain as it should be becomes the predominant issue. It may seem understandable that the pain itself should be easy to identify and for many this is not the case and the very reason we are attending the pain clinic in the first place. We feel that having identified the origin of the pain, a successful outcome would follow; this for many is not he case. The diversity of pain clinics modes of improvement are varied and although we might have expected them to be similar each one does it how they perceive is the best option.

    Melzack and Wall the eminent pm doctors suggest a “multidimensional approach” to pain management has proved to be the most effective so perhaps we should look at additional procedures that may initially be unfamiliar. The important thing is to be receptive and adaptable and give it a go, it may work for you or may not, who is to know unless you try.

    We all enter this process having lived with pain for some time and the expectation that it should have gone already and place high expectations on results, we are understandably sensitive to how this treatment is provided, our confidence or exuberance may have diminished over time and we should applaud every effort that we make.

    My own PM residential consisted of a four week every day attendance, with doctor’s physiologist’s physiotherapists, we did most of this process in groups with others and discussed how living with pain and how to adapt to this lifestyle, they never said our pain would be eradicated or even reduced and some are sceptical of a none invasive process having any long lasting success. It eradicated the myth that others have to be in pain to understand us, those staff were the most professional and never questioned anyone’s integrity of the pain they endured everyday. They supported us with knowledge and understanding.

    Finding that balance of when we are taking adequate medication for it to have some effect and not too much so that the side effects of the medication become more problematic than normality itself is always difficult, it is reasonable for anyone in pain to continue taking more and more medication in the belief that this is the answer, it brings up red flags to how we deal with pain. Not expecting to be pain free is a good if not unfortunate reality, so any improvement will seem like success.

    Take care and good luck


  • the dr gives you x amount of pain meds to be taken x amount per day. People say but i am still in pain why can't i take more meds to help me? probably,pardon me for offending people, one of the worse , not dumbest, things one can do. first of all pain meds don't get rid of pain, you will always have pain even if you take 100 percocets a day. you will be dead, but you will still have pain. your dr is liable for your care and use of pain meds. if one takes more meds than needed and you die or get in a car wreck, the dr might be in trouble along with you. they are checked out by the dea constantly and it is very easy for them to get into trouble with prescribing these meds. one dr of mine had to take a seminar because a copy of a script was missing when the dea was auditing him. the dea looks at them as legalized drug dealers so by taking more meds than prescribed makes it hard for him and the rest of us who use narcotics and use them correctly. i have never had to take a blood test or have the dr count my pills because is use my meds the way they are supposed to be used. i had gall bladder surgery and i was in more pain, but i did not ask my dr for more meds. he said taking more meds would not help my increased pain level. one reaches a saturation point with narcotics and taking more won't help. so you take more, then what? you will need more when your body gets used to this amount, then you take more, then you get used to your new amount, i think you get the point. by using your logic, you will have to keep taking more and more with no end in site. if you have a problem, ask your dr, and if he says no, then so be it. bite the bullet and use what you have.
    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.
  • No I get that the pain won't be gone but at the moment that was not quite the thought process I had. Lesson learned.

    And to be honest the problem is that when I did call and talk to the nurse she would tell me to take additional meds to help. So I am not constantly taking additional meds, unless directed to. Too bad no one ever mentioned that if I ran out I would have to wait to get them refilled. This still seems to be learn as I go and am not perfect.

    I see my new doc on Monday and am hoping he will guide me a little better with all of this pain management stuff then the last has. I am not stupid my any means but this is not something I have ever had to deal with and have made a mistake along the way and did not ask enough questions. Call me nieve I guess, or I just wasn't thinking. I in no way want to get anyone in trouble, docs included, or jepordize the rest who use narcotics correctly. One mistake does not make me a lifetime offender.

    Like I said, lesson learned. I have stuck to, and will be continuing to stick to what I am directed to take and no more. Unfortunetly I feel like it is the blind leading the blind rigt now, which is why I have switched doctors. My last doc did not seem too interested in even attempting to help with my pain. He seemed to think spine issues are cut and dry. here have surgery and you will be perfectly back to "normal", problem solved, NOT.

    This all just really sucks, plain and simple.
  • When the doctor is not giving you enough pain medication to be able to live a somewhat decent quality of life - there is a problem - with the doctor. I understand that doctors are under scrutiny however, I also think that many of them have not endured the type of pain that makes you just want to go blow your brains out. Is that better? Is that a better option, than taking an extra pill because your in agony? Is that what they want? Sometimes it seems that way. I had major shoulder surgery and was allowed exactly what I need, a pain pill every 4 hours. After major, major surgery, I felt better than I had in years because it was under control to a reasonable level. Two months later, I get jacked back down to a pain pill every 6 hours. WHY? Oh, her response was because if you ever need another surgery, you won't have any room to move. Are you kidding me? I have to suffer daily because someday I 'might" need another surgery? Talk about stupid... Ya, I gotta disagree with you on that one.
  • No offense intended, I wrote that wrong!
  • Yes, doctors should be controlling our pain, but some of what they say is true. If we are young, and they start jacking up the opiates now, we will develop resistance and there will be nothing for us when we get older.

    The truth is, what they are not telling us because they don't want to depress us, that there aren't really a lot of good options. The way opiates work, they will be less and less effective the longer we use them. Shots only help some people and some disorders. All of the other meds- the antiseizure meds, the NSAIDS, etc., are very hit-and-miss.

    And, of course, opiates are only moderately effective. We take one, it takes away 10% of the pain, we might think if we take another it will take away another 10%. But instead once they do what they can do they start making is sleepy and out of it, and then they start making us dependent. More opiates aren't always the answer either (right now, my vicodin isn't even doing 10%. Two tylenol does a better job).

    I know this got long, clearly I've been thinking about this stuff. We want someone to make us feel better, but short of a morphine pump, which would not help us have more active lives, there aren't great options. I hope they continue research on these issues and keep developing new methods to help we of the bad back brigade to keep leading happy, active lives into old age!
  • One lortab 10 takes away 90 percent of my nerve pain and works on the arthritis burn too. That is why I don't understand the reasoning, that you have to have 100 percent pain for 2 hours in between.
  • dilaurodilauro ConnecticutPosts: 9,859
    to continue to medicate a patient until the patient is pain free.

    Doctors will and should only prescribe what is necessary, reasonable and required for their patients.

    Saying that a doctor has not endured the pain that their patients have, has no bearing on how they need to regulate medications.

    There are way too many drug seekers, people who over emphasis their pain, whine all the time in order to get more pain medications.

    I think it is a credit to our medical field and doctors that they are able to see through those folks and do what is really needed for those that warrant it.

    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
  • There are a few out there that ended up offing themselves because they cannot find a doctor that will provide them with enough relief.
    We all know there are drug seekers, but many of us also know that doctors can be stingy with the meds needed to control things. I'm sure some doctors are more accomodating than others are; I'm sure that some people have more pain than others; I'm sure that some pain patients do a lot more than others on a daily basis. There are many factors involved. I think if one says they are not getting enough relief, it doesn't mean they are whining. I think you have to take them at face value unless they prove otherwise. I know that nobody else has any idea of how I feel.
  • One thing everyone needs to keep in mind is the insurance in this. Most insurance companies use outside firms to make sure the treatment matches the condition. Yes there are protocols for the drugs as well. I was just recently auditing some bills and found a really odd one, in the mess. It was a accident I got the copy. The insurance company paid to have my conditioned analyze to see if the condition matched the level of meds I am taking. Lots of your doctors own these programs as well. They put in the condition and out spits the answer as to what would work to control it. More and more doctors, hospitals and Insurance companies are going to these programs. It helps with errors and of course to keep cost down. All of our doctors are aware these systems are out there and they may never tell you they use them or they know they exist but they do. They also know if they prescribe outside the box they could put their practice up for examination by the feds. I kind of look at like I am running late for something I know I can speed but around the corner may or may not be a police officer do I take the chance or not. In my world no I don't like dealing with it period.

    I have had surgery and meds increased for surgery and those extra meds taken away after surgery as they were treating the acute pain caused from surgery. But also while after surgery I was getting lots more rest than normal. But after so long I returned to my normal amount of rest.
  • I do understand what you are saying but at the same time it is frustrating. I know the doctors have to be careful on their end because of drug seekers but it makes it really hard for me to get the care I need because of it. Heck I am so leary of what I take that I just called the pharmacy to make sure I can take allergy medicine with my pain meds. I call them when I start taking new vitamins to make sure it is kosher.

    I am willing to try anything the doctor has to offer. I am not only looking to get pain meds. If they have a better plan/course of action that they think will better suit me then I am all for it.

    I really am not sure what else to say about the subject. I feel like some of the posts were a little on the offensive side as opposed to advice, which is what I normally come here for and have always gotten. I really do not know what else is out their other than injections and the pain meds I have been introduced to.

    I guess I really am more nieve to all of this than I thought, well up until my gp told me about some lady that literally breaks bones to go to the ER and get pain meds, which totally blows my mind away. I really never knew people go to those kind of lengths. I have never been the type to abuse so when I did take a few more pain pills than normal, I did not think anything of, no harm done. Right???? Wrong!

    I am frustrated, tired, depressed, hurting, and over life in general at the moment.

    Have a good weekend all.
  • dilaurodilauro ConnecticutPosts: 9,859
    We cant know how you feel.
    Pain is subjective. Your pain level of 9 could easily be anothers's 3.

    Always keep in mind, doctors are not subjective, they are objective and they know what and when a patient needs something.

    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
  • using words like agony, so bad i cry , worse pain i have ever had, etc. all of these phrases some use smack like whining to a lot of pain dr's. yes i have had 4 major back operations, gall bladders stones and kidney stones, and all of these phrases sound like exaggerations to me. when i take my pain meds for these, i know that all of the pain won't go away. dr's hear this all of the time and react accordingly. i think a lot of pain drs. hear this all of the time and they think some are exaggerating their pain levels. this is why pain drs are sometimes difficult to deal with. they give meds to help pain and patiens come back and complain. pain dr's can't win for losing. once again by upping your meds you build a tolerance and it becomes a vicious cycle, still in pain and then you have used up all of your meds and then the dr won't give you more because you've gone over your limit
    just my humble thoughts on the subject
    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.
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