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problems with pain doctors and or clinics

terror8396tterror8396 Posts: 1,832
edited 06/11/2012 - 8:42 AM in Pain Management
once again as i read the post, i see the same complaints, my pain dr won't help me, or things i am seeking drugs, i go in and he gives me nothing, all he wants to do is give me injections, etc. why do so many people have problems with pain doctors or clinics? i hardly ever see or have never seen a post that says, i have a great pain dr and we have a wonderful relationship. well i am here to tell you I HAVE A GREAT PAIN DOCTOR AND WE HAVE A WONDERFUL RELATIONSHIP. i aks myself why? i have been with this guy for 3 years and before my last pain doctor retired, i was with him for 8 years. I HAD A GREAT RELATIONSHIP WITH MY OLD PAIN DOCTOR. once again why" why do a lot of people complain about getting bad treatment from their pain doctors? here is my opinions and things i have done to help my relationship with pain doctors. first i don't go in and complain that i am in a lot of pain and i feel like crying all the time. if one goes in to a pain dr what will he think of this? well he sees people all day that are in pain. this is his job and he probably knows that some are in great pain so he doesn't have to be reminded of this. yes he knows, and he is here to help. second, he hears that my naisd are not helping me. the only thing that has helped me in the past is percocet. nothing else helps. major red flag, dr thinks here is a drug seeker. third, he only want to give injections, well a pain dr has to go through certain steps to see what is going on. injections helps him determine where the pain is in your back. he does this by blocking cerain parts of back. fifth, why do i have to sign a contract or have blood test? to protect him and you. sixth, he doesn't like me and won't help me. why? maybe coming in and complaining all the time turns him off. I believe if you have a postitive attitude and don't demand or complain or as they see it whine, you will probably have a good relationship. i believe most pain ddrs are good and want to help it is up to you and your attitude towards him that will help the most. by the way, i have signed a contract, but never had to have blood test or pill count. why? he trust me and knows i do what he tells me to do
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.


  • Well I do have a great PM DR. He was heaven sent.I had to go thru a few to get him and no way will I give him up.

  • dilaurodilauro ConnecticutPosts: 9,833
    I too have a long term excellent relationship with my Pain Mgt doctor. If it wasn't for her, I would be definitely in worse shape today.

    When we have been members on this site for a long time,
    we do see so many threads about people who

    - Dont like their pain management doctor
    - The doctor wont give me more pain medications
    - All they want to do is injections
    - Or send me to physical therapy
    - etc

    Many people believe that pain medications are going to eliminate all pain and when they take those medications and are still in pain, they want more and more.

    I've said this a hundred times on this site, there is no magic pill to make you feel great again.

    Its hard work for the patient. Besides the mix of medications you need, there are the other things, exercise, diet, etc that is so necessary to control and manage pain.

    I believe only people who have lived in chronic pain for a long time can really understand this.
    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 have a great PM Doctor. I inherited mine as my care shifted from surgical follow up to long term pain management. He is part of the practice that performed my back surgeries. He has never offered a superfluous procedure to me. The 2 nurses that work for him are fantastic young ladies and a credit to his practice. The nurses have told me that I am one of their favorite patients cause I have such a cheerful outlook on life. These people who look after me need to be commended for what they do, for they have seen me at my worst. Can you imagine dealing with people in constant pain every day, every week. I'm sure it gets overwhelming to them also.

  • I agree so much. I actually feel bad sometimes telling my pain doctor who much pain I am in. I told him once before I wouldn't want your job to listen all day long to people saying how much pain they are in. But I do go in with a plan when I see him, so it is just not about talking about pain. I do a lot of journaling with the pain and the current meds, to see if there is a time of day I don't have enough coverage to keep me going. To keep me out of oh that hurts bad pain and down to the it is there but I can deal with it. At this point and time i realize there is no such thing as being pain free.

    Sense I am work comp it is very hard on my pm doctor to treat me. He would like to do more but is only authorized to prescribe meds. So it is what we have to work with, and I appreciate him working with me to utilize those avenues to the best of our abilities for pain control.

    I think some don't realize it is pain management. Just because some other doctor said your pain is coming from xyz the doctor who is going to treat you needs to make his own diagnoses. I have to say I have been treating with my pm doc for 2 1/2 years now. In the beginning we had a rough go but it was from lack of understanding or denial that my condition had gone to chronic. The only thing we didn't retry was a med a had a severe reaction to. I didn't like the fact at first we were redoing some treatments that failed in the past, but he made me see that something may have changed and they may help. I soon caught on to that belief system and I was willing to try everything that he wanted. We finally came up with the right mix of meds to help control the pain. We have recently talked about making a change in one of my meds but he said up front you will need more than likely to be in more pain through the change to get to the desired results. Some may think that is hog wash but that is the way he does it and I am agreeing to let him treat me so I agree to that plan. I appreciate that he was honest gave some meds to think about and go home and research the ones he feels may work. I have some control but he made the choices, and I feel comfortable with it. But I do feel good about his care in helping me through a difficult situation and doctoring with one hand tied behind his back.
  • I'm in a bit of a different situation in that my surgeon and his spine clinic have been handling my pain and muscle medications since before my ACDF in 2008, so 1-1/2 years. I signed a paper before both surgeries that they will only manage medications for three months after the surgery, but I know that my surgeon and his office understand what I'm going through and we've built a very trusting and honest relationship.

    I've never asked to have my meds upped. I have told him what meds I won't or don't want to take (like oxycontin because we have a friend that was addicted, and at my last surgery I asked not to have a dilauded pump. I said anything else, I don't care, just not dilauded as it did nothing for me during my ACDF recovery).

    Every time I had an appointment with my surgeon or his PA, at the end they would always ask, "Do you need any more pain medications?" I always say "no, you just refilled them" or "what I have is working fine." They're looking at they're records when they ask and it's probable that they're checking to see if I'm seeking more meds. One time, at the end of a visit with my surgeon's PA, I said "I need to talk to you about my pain meds." She sighed and it seemed to me like she was thinking I wanted to up them, but I only told her that I wanted to take the same med, but with less APAP because I'd been having stomach aches.

    Just recently, I called my PA and told him that I wanted to wean off my pain meds because I need to see where I'm at with my pain and I want to lower my tollerance because I'd like to get to the point where I don't have to take them daily, just have them available for when I have significant pain.

    I say all this because all of these things have built a mutual trusting and respectful relationship between me and my surgeon and his PA. There's never been a problem with getting any of my meds refilled and they've never delayed refilling them. I've had times when I needed to take more than the prescription read and I'd call the PA and talk to him directly telling him I needed to do this and needed his ok because I might need a refill early. Because of our relationship, it was never a problem.

    I totally understand that I may never be pain-free every day, but the medications that I took after my ACDF in 2008 that took the edge off still take the edge off today, having been upped in mg only once along the way. All I want is to be functional - I can make it through pain, but some days I just need some extra help.

  • I to have a love affair with my new physiatrist. I wasn't sure if he was the dr. for me, because I was a patient of his partner. And I had great respect for that dr, and he helped me a lot before my fusion. But he had a family situation, and I was transfered over. After meeting with him, talking with him, and listening to him. I found that he was the pm dr for me. He understood my fears of certain procedures, medications, and esi's. He made it clear that he would handle my case, and not force me into something I wasn't ready for. He just made it clear that there are other options.

    He cares about all of me, and not just my pain. He cares about my health, my state of mind. I found this very unusual, and surprising. I'm so thankful to have found him. He doesn't prescribe ton of meds, so I rattle when I walk. He prescribes one at a time to make sure they work, or if they need to be adjusted.

    We have set reasonable goals for me to be able to do. I will never be able to run a marathon, heck I couldn't run one before fusion. lol But I should be able to go shopping for a few hours without having to recuperate for days later. I should be able to take my dogs for a walk around the block. Simple things! He has enabled me to do a lot of these things, and without that fog. Like my mom say, " The lights are on, but nobodies home. Now, the lights are on, and there someone in there."

    Some day my new pm dr seem to good to be true. I can't imagine now ever having a new pm dr.
    Bobbi Jo
  • Jon,
    In affirming our collectiveness and norming we encourage honesty and being true to ourselves. Our pain for the most part is supported and influenced by exterior guidance as we look expectantly to the medical profession to repair our chronic existence. That is reasonable, we have been encouraged to believe that eradication is possible where possibility becomes reality, we all need that hope and are driven to secure its acquisition as a reasonable and more importantly, achievable objective.

    Perhaps we only hear what we want to and dismiss all those things that we perceive are unhelpful in this quest, we do not want to know as Ron said in a recent post that medication will not work, even treatment has the perception of possible improvement that are never achievable, it take times to find that disappointment.

    My professor looked me between the eyes and told me the truth, he saved me from myself, “ go on have another operation maybe 2 of 3 more, take as much medication as you can swallow, go home and live a restrictive life” is that what I would have wanted him to say, he told me my reality and I thank him, others told me what they thought I expected or wanted to hear, set me on the path for unrealistic hope or expectation which never materialised.

    Do not make everything a drama, where the doing becomes more important than the pain itself, why do we go if we have already made up our mind that we ourselves know how the problem can be solved, in our career would we ask someone how to fix something with no experience.

    Pain clinics here come in for some criticism and we are right to hold them responsible for doing what they suggest they can do, even the notion of managed pain is far more illusive for many here as we live our lives in excruciating pain. As Jon said, this is a partnership and it takes time, would we support individual with the desire to seek more and more medication, if for one second we thought that strategy would work everyone here would be encouraging of it, it is a myth. Bad and questionable provision should always be avoided at all cost and in asking each other where to get the best treatment, we are supporting best practice and omitting those establishments not up to the job.

    What would we do when someone asks for increasing medication, it would seem cruel and insensitive not to help them, and in denying them we would be helping them more than they understand or perceive at this time, doctors are frustrated in not being able to help us. Knowing when it is not working is not easy, and change for us is always problematic, in allowing expression some continually complain, I would rather support and encourage all those looking for answers, and here they should feel encouraged to divulge difficulties so that collectively we can all help them to help themselves and each other.

    My residential PM team were fantastic and I am indebted to the skill care and understanding they provided, with love, knowledge and empathy.

    A great subject…

    Take care John
  • dilaurodilauro ConnecticutPosts: 9,833
    if we could just connect to a medical device and our real pain levels would be identified!

    Then it would be much easier for the doctor to determine what medications and at what dosage would be appropriate.

    Until then, its a matter of honesty between doctor and patient
    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
  • To add insult to injury, the good PM Doctors have to deal with the junk that this article, "Despite probe, prescription drug abuse worsening" found on the font page of today's Washington Post writes about.

    They're are a lot of stupid people out there that just make it hard for those that truly need help.

  • ..with my PM doctor and the respect and trust is mutual since I've been going there for a few years now. I never did anything to hinder this trust; I get my drug screen done regularly and I've never run out of meds before my next appt. I've done everything asked of me and I always am open to try new things. At each visit I'm asked how I'd doing on my meds and this gives me an opportunity to let them know if I'm not getting adequate relief. I never asked for dose increases but my doctor will offer to do it if he thinks it's necessary. I also try other self help measures such as using ice packs or heating pads to help fight against the pain and not rely solely on just the pain meds.
  • My pm doctor only give injections,he is the one who does the Rhizotomys in my lower back, my primary doctor is the one who prescribes my pain meds. I do have a contract signed with my primary doctor,i have been tested 1 time ,and i was clean. I do agree that it takes time to develop a trust with your doctor...
  • Studies seem to support the idea that a lot of chronic pain patients are not getting good pain control. So even though some of us might be doing OK, that doesn't take away from the people who are struggling to find doctors who will treat them appropriately.

    I changed pain doctors recently, but not because of any problem. I *wanted* the injections and their facility wasn't on my plan. I'm glad I did, the injections have helped!

    But I wouldn't assume that you have gotten good pain control just because you're doing it right, and they haven't because they are doing it wrong. There is likely a certain amount of luck there as well, in getting pain management doctors who are willing to go as far as they need to go to treat your pain.
  • I have turned down 2 referrals to a PM. I did not want injections, I fiqure they were just a temporary fix. I do have a pain pyschologist, who has offered great techniques for not dwelling on pain, or getting through rough periods. It makes me feel like I have more control over my pain. But I will admit it doesn't always work, but it gives me ideas to try before grabbing a pill.
  • Something to keep in mind, is that doctors, like to see patients involved in their own care. If after an initial evaluation the PM doc recommends starting with an injection, if you say "no thanks", it's going to be like telling him you don't have any confidence in his abilities as a doc. Many times, it pays to humor them and let them run the tests and try different treatments. What they like are patients who give good quality feedback on these procedures and treatments, so they can better judge for the next time or next patient.

    I guess I'm trying to say, just keep an open mind.


  • Please provide a link to the said studies or refrain from the blanket statement.
    happyHBmom said:
    Studies seem to support the idea that a lot of chronic pain patients are not getting good pain control.
  • Most of the articles I've been reading are on medscape, which requires registration. But here are some articles which cite studies:

    This one is a good start, but I have to get my kids to school.

  • "Neuropathic pain syndrome is a challenge to treat and, even with appropriate evidence-based treatment, only a 40% reduction of symptoms can be achieved in approximately half of patients. Furthermore, efficient doses are often difficult to obtain because of adverse effects. These observations underline that the treatment of neuropathic pain is still an unmet medical need."


    references are provided
  • "The most important message that physicians must communicate to persons with chronic pain is that, currently, no medication exists that will take away more than 30% of the pain they experience. Chronic pain is a chronic disease and, like diabetes or hypertension, requires chronic concessions and lifestyle modifications"

  • See, the articles you reference say something different than what your original post stated. You indicated that Doctors are unwilling to treat their patients, whereas the articles support that chronic pain is difficult to treat and 100% pain relief can not be achieved.

    I know you mean well, but you need to be careful in stirring the pot in that Doctors are bad. That thread comes up regularly on this site and in my opinion does not reflect reality.

  • No, I did not say that doctors are unwilling to treat patients. I said patients are having difficulty getting good pain control.

    The 40-50% is the maximum. It makes sense that it will take trial and error, both with finding the right doctor and the right medications, to get to that point.
  • Just an observation from someone who does not see a PM doc and hopes to never do so. But I have read these Pain Meds/Mgmt sections on here and see a theme.

    The ones who do great with their PM docs seem to have somethings in common:

    1. Long term relationship
    2. Willingness to work with PM doctor
    3. Don't name drop or suggest medications

    While there are new patients and newer PM docs that just hit it off quickly.

    It seems to me that the ones who have a longer term relationship, will try what the PM doc wants even if they don't completely agree, and don't tell the docs what pills and doses they need. Those seem to do well. I suppose this is just a generalization but it seems sensible.

    I'm with tam, I wouldn't want their job. I don't care what they get paid.
  • Not trying to start an argument here. Your following statement:
    happyHBmom said:

    No, I did not say that doctors are unwilling to treat patients. I said patients are having difficulty getting good pain control.
    does not say:
    happyHBmom said:

    So even though some of us might be doing OK, that doesn't take away from the people who are struggling to find doctors who will treat them appropriately.
    The last quote specifically states that doctors aren't treating their patients appropriately. Please be more careful in the future in how you word your posts if you don't want your words taken wrong.

  • There were two different points made in that post. You asked for documentation on the first point- do you need documentation on the second as well?

    I have struggled with severe and complicated medical issues for 10 years. Of course people sometimes have to look around for a doctor who is going to treat them appropriately. Not all doctors are created equal. Some are just plain better than others.

    Pain sufferers have the added complication that some doctors are hesitant to use opioid medications, which are one of the few effective treatment options. If 50% is the best you can hope for, are you going to accept a doctor who is offering you 30% because he won't use all of the tools at his disposal?

    If you have time at your disposal to form a relationship with a pain doctor, great- but what about the people who have severe chronic pain now? Do they just not get pain control at all until that magic time when the doctor finally decides they are trustworthy?

    It's a tough situation. I wouldn't continue to see a doctor who I really believed wouldn't use whatever tools were needed to do the job. That doesn't mean I'd necessarily agree that you can identify such a doctor on the first visit, but they do exist, and I think people who aren't getting effective pain management are justified in leaving them to look for a doctor who is more willing to use those drugs.

    That said, some pain can be effectively managed without them. I think it's a very individual thing.
  • They were before my surgery, and I was told both times "we could try this" without much confidence behind it. I know they were just insuring I knew my options.
    I think going to a pain psychologist implies a pretty open mind. I am willing to try the mind over matter approach, if it was going to help with pain and improve my outlook. I was very doubtful at first, but I have learned there are a lot of psychological aspects of pain. It definitely increases with anxiety. It also can increase in women while hormone levels are changing, tell those male DRs, NO, it is not only in our heads.
    I also learned how to redirect it, concentrating on other sensations in my body. Very interesting, and helpful.
  • You know what HB means, there is no need to dissect her comments b/c after all, she is just stating her opinion.
  • Well said. There are good and bad in every profession and, unfortunately for us, doctors are no exception!
  • You people aren't worth my time and effort.
  • I offered to support my second statement if you wished it.

    I am not a doctor. I am a person with a permanent back injury, chronic pain, and various other complications. As such, part of my responsibility to myself is to make sure that the doctors I see are using all of the tools at their disposal to help me, and if they refuse to do so, I can find another doctor.

    I'm not at all sure why that bothers you. Doctors aren't gods. I am in the situation I'm in because of a series of medical errors- they happen all the time. I have learned my lesson about assuming that the doctor knows best.

    We should all have PM doctors who listen to us, who take our pain reports seriously (yes, even if we are a bit dramatic), who explain their decisions to us, and tell us what is expected of us. If they aren't doing that, they aren't providing appropriate treatment. If we're leaving the room thinking "why didn't he change anything when I am in so much pain?" or "I know there are options he's not using, but when I suggest them he pretends he didn't hear me" s/he's not doing his job.

  • Of a finicky eater.

    There are those who would rather starve than eat something they determine is distasteful or not to their liking. Most of the time this person doesn't even sample the food, but simply refuses it.

    There are those who will send food back to the kitchen over and over or refuse to patronize certain types of restaurants, just because they serve something that doesn't suit their pallet. This type will even go as far as getting up to leave an establishment once they see the menu. This is the person who makes accepting invitations to someone's home for dinner, virtually impossible.

    Of course then you have the individual who doesn't necessarily like everything on the menu, but gives a few items a chance and leaves with their hunger sated, but convinced to not repeat that selection.

    Then there's the individual that walks in, sits down and says "bring me the special" without even knowing what it is.

  • Ah, to use your comparison.

    If you have to choose one restaurant, which will have to meet all of your nutritional needs for the near future, which are you going to choose? The one with a varied menu that includes the foods you know you like, or the one with a limited menu, some of which you've tried and decided you didn't like?

    Or worse yet, one that can't meet your nutritional requirements? Maybe they only serve ice cream and candy?

    Aren't you also going to want the restaurant with skilled, capable chefs and an A+ cleanliness rating?

    After all, you are what you eat! ;)
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