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Am I the only one who can't seem to find a comprehensive PM doctor?

Reformed1RReformed1 Posts: 257
edited 06/11/2012 - 8:45 AM in Pain Management
I'm at a little more than 6 months post-op from a TLIF at L5-S1 and my pain is worse than before surgery. I have no doubt that the fusion was performed flawlessly. A CT Scan and MRI seem to confirm that. Nonetheless, my pain is in exactly the same place and it is more intense than before surgery.

I've tried to get my NS to look at my situation holistically. I even obtained a second opinion from another NS. The second NS admitted to me that they can get tunnel vision and tend to look at everything from a surgical perspective. Now my first NS is arbitrarily telling me to reduce my medication even though my pain is worse. I don't get it, and I'm convinced that he is actually confusing me with other patients based upon some inaccurate comments about his recollection of my history of symptoms and treatment. To be fair to him, it wouldn't surprise me if we all started to sound the same after awhile.

I have posted in other threads that I am trying just about everything available to resolve this pain. I do feel that it's time to find a PM doctor who can help manage the whole picture. I found a great PM doctor, but he only does injections. His office tells everyone flat out that they don't prescribe narcotics. If he could manage my pain without narcotics I would stick with him, but I get the sense that they really don't even want long-term patients.

I've searched on my insurance website for Physiatrists and there are none on our plan. In fact, I can only find 3 in the entire state of CT. Again, none are on our plan (and this is one of the largest Healthcare providers!). Also, every doctor that I have looked into who is listed under Pain Management will only do interventional PM (i.e. injections).

I feel stuck between an NS who doesn't seem interested in treating my pain any longer, and I don't think that the injections alone from my PM doctor are going to be the complete answer. Unless I can find someone to take over my holistic PM treatment soon, I fear that I am going to be left out in the cold.

Any ideas as to what type of doctor I should be pursuing?



  • Not that my answer will help, but I will say that my first visit to the PM doc was my last. The practice itself sounded perfect..a neuro fellow, an ortho fellow...PT, PM, etc.

    This guy pretty much shocked me out of wanting to get help from a doctor and/or practice I don't know and I ended up just going back to my GP. Not ideal, but for my own piece of mind and some pain management it's a lot easier for me to handle.

    From reading here I had learned about contracts and all. Years ago I set up my mom's PM appt and it went quite well... I didn't know then that her PM doctor wasn't the norm.

    I hope you're able to find someone soon that can help you manage your pain. Depending on where you live in Conn, and if your plan allows= is there someplace out of the state that you'd be allowed to go? Like Greenwich/ Westchester/NYC area or something like that? You might have better luck widening your search area.

    I hope you find someone soon.
  • This is just an idea, but with my insurance if there isn't a specialist within a reasonable distance on the plan then I can submit a request for "courtesy" coverage. If you find a physiatrist in your area who isn't on your insurance you might call your insurance to find out if they do something similar so you can get coverage.

    I am so sorry the PM you are going to only does injections, and think you're right that you need someone else since it usually takes a combo of things to manage chronic pain. Have you checked your local hospitals for pain management? A lot of hospitals have pain clinics associated with them, so that might be a place to start. You might also search for spine practices.

    I think you may be misled by the "interventional" title. Every pain doctor I've ever been to has been an interventional pain management specialist and they all do everything from meds to injections. In fact, I would say it is highly unusual for a pain management doctor to *not* do meds since a lot of pain management (even when sufficiently managed with injections) still requires at least some medication for breakthrough, etc...

    If a physiatrist is really not an option I'm not sure where else you would go...I'm guessing perhaps there are more anasthesiologist practicing pain medicine in your area? You could try searching for those. You could also talk to your GP about helping you with the meds until you are able to find a specialist. Your NS may also be able to give you a referal to a good PM doc.
  • Lala touched on what I was going to suggest. Many of the big hospitals have pain management that uses a multi-discipline approach. Basically imagine a review board discussing your case and making the determination where to start and who's best to manage your care. I found this out recently and the difference between those types of clinics and just a Pain Management Clinic are astounding.

    I moved last year and so needed to get set up with a new PM doc. I was referred to a Pain Management Clinic that quite frankly felt like visiting a technology arts and crafts fair. The push was to figure out which implants would serve you best. So my PCP requested a second opinion from a large hospital about 2 hours away. I went there and it was a completely different experience. Within one week of my first appointment with this clinic, I gained back around 30 hours a week of my life and feel significantly better. They are now in the process of making a recommended long term treatment guideline that my PCP can follow.

    I had to contact my insurance company and ask them how my PCP needed to word my referral in order to get this approved. The insurance rep was very helpful, my doc resubmitted the request and I had the approval by the end of the day.

    I hope you can find someone to assist you.

  • Some PM doctors are anesthesiologists. Mine is a psychiatrist, but I don't think it's necessary.

    You know what I like? Those online rating programs that allow regular people (like us) to rate doctors. I use those a lot when I'm doing research on doctors. They'll often tell you what people's first experience with a doctor are, which to me is a big deal.

  • Thanks, everyone for your very thoughtful comments. I really appreciate it!

    I have overtly asked about the scope of services from a number of Pain Management departments associated with various hospitals in CT and everyone is telling me that they only do injections.

    On a positive note, I just met with my NS's PA and she was wonderful today. I came prepared with a log of my treatments and all of my medication, including a graph showing trends in usage. I think I demonstrated to her how hard I am trying to not use narcotics. I left there with what I felt was a reasonable agreement on a daily dosage -- not the most comfortable for me, but one that I can live with and one that I will actually feel good about because I will continue to try to reduce as best I can. My goal is to eventually get off of all narcotics (in what year, I don't know!)

    I am going to have a CT Scan in late September to confirm my fusion took (high probability based upon early progress demonstrated in an previous CT Scan). My PA is allowing me to maintain this level of medication until that timeframe. I am doing an extensive list of alternative therapies as well as meds, and we agreed that if I haven't improved by September, she will help me find a good PM doctor who can take over my entire PM requirement.

    It was refreshing to see the PA really listen and respond, especially when my NS was not really doing so.

  • I am also not getting the contact with PM doctor. I consulted him last month but after that I can't. I was referred to a Pain Management Clinic through my friend that quite frankly felt like visiting a technology arts and crafts fair but it was not the good experience. I really need a PM doctor.
  • I have an appointment on 8/20 to see a Pain Management practice associated with a local hospital. It was interesting that my NS who performed my fusion back in January wouldn't provide a referral to them because he felt that they were too liberal in providing pain medication (Red Flag to me -- I'm still in a lot of pain!!).

    I had to go get a second opinion from another NS and he was very objective about the fusion probably being performed perfectly and that it is probably fusing nicely at this point, BUT that it didn't address the root issue which is causing me continued pain. Thank goodness for THAT conclusion. He referred me to the suspect PM group mentioned above and I asked about them and their reputation. He said that he has had very good experience with them and that they are the only "holistic" PM group in the area. Again, thank goodness I sought out a second opinion.

    It's frustrating, though, that my original surgeon seems to have tunnel vision -- surgery went well = no cause for continued pain? FALSE! He failed to correct the root issue.

    Anyhow, I have confirmed that this group will take over my entire treatment plan including all injections, meds, and even narcotics as needed!

    Why is this so difficult?

    Have a great day!
  • First impressions mean a lot, but I was pleased with the substance of my first visit as well. I walked into a pristine office an hour earlier than my scheduled appointment (as directed). I filled out a detailed questionaire that addressed both the physical and psychological aspects of my situation. I then met with one of the nurses who did the basic vitals and then we had a half-hour detailed discussion about my history. I loved her personality, her compassion, and her professional approach. She obviously knows about pain. She briefed the PA and he promptly walked in the door right at my scheduled appointment time with him.

    He seemed to already know me very well. He did a usual neurological exam and then rather than repeat all of the basic questions about my history, he honed right in on my unique issues, challenges, and successes. I was so impressed with his technical knowledge. For example, I had a genetic test done to see which medications I would not be able to metabolize, and before he even looked at my report, he was explaining to me how certain pathways are used to metabolize medication. He and the nurse worked with me to establish short-term and long-term goals. I really appreciated that aspect of the visit. This process took the second hour of my visit.

    Toward the end of my appointment, he prescribed a new medication (Nucynta) because he thought it would help me given my particular pain issues. The nurse came back in and reviewed the pain management contract with me. I hated to succumb to that rather demeaning document, but I understand that it is the price I must pay in order to have this group effectively treat my pain. Okay, I'm over it already. I have placed my trust in them and now I expect them to be completely responsive to my needs.

    Here's the best part... I haven't even met with the doctor yet and I already love this practice. I met a couple of the nurses and also the PA, and I feel like I finally found a PM group that is going to help me. I'm meeting with the doctor in a few weeks, but the PA was so talented and so thorough that I'm not even worried about the doctor.

    My only issue at this point is that I'm not tolerating the Nucynta very well. It's making me sleep constantly. I also feel like I'm going through withdrawal from abruptly stopping the Hydrocodone. No worries, though, because I trust that they will make any necessary adjustments.

    I think I finally found the PM practice that I was looking for!!

    Take Care,
  • Thank goodness. Sounds like the group I am going to. Same type of wrap around care. I see one doctor, two nurse practitioners and they have a fantastic support staff.

    The contract is a bit demeaning but we know why it is needed. I was prepared for that but still a bit uneasy. Can't wait for that first screening :)
  • Bravo! That's good news. In any medical office, if the staff are happy and professional, it generally reflects on the docs that work there. If the staff are cranky, you can bet that there's a good reason for it.

    I really hope this new place works out for you. Looks like we are both in the process of getting established with a new PM doc and clinic. I had my second appointment with the new place and I left there feeling very confident that I am in good hands.

  • To quote you, quoting Stimpy... "Happy Happy Joy Joy"!! :)
  • I just noticed that at least two of the doctors at this PM practice went to Med School somewhere in the Caribbean. I'm not mentioning the names of the schools because I don't know if it is allowed.

    This scares me a little, especially since my NS warned me not to go to this practice. He called it a "black box" -- that you don't know what they are really doing. Part of me has written off his comment as being a grumpy person, which he is. However, I do wonder about the caliber of doctors trained in the Caribbean. Why would they go there for their MD?

    I did check out the credentials of the school that my particular doctor went to and it is accredited. It is also certified by NY, NJ, and perhaps the other states who do special certification of internationally-education physicians.

    I have no issue with them prescribing meds, but now I'm a little worried about them sticking catheters and needles in my spine should that be required down the road.

    Does anyone have insight into this?

  • I just posted that I'm happy for you, but I didn't read the above post. I don't know much about obtaining credentials, so I can't help you there. You can look up the doctor on the state's website to make sure that they don't have any disciplinary actions against them.

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