Welcome, Friend!

It looks like you're new here. If you want to get involved, click one of these buttons!

Veritas-Health LLC has recently released patient forums to our Arthritis-Health web site.

Please visit http://www.arthritis-health.com/forum

There are several patient story videos on Spine-Health that talk about Arthritis. Search on Patient stories
Protect anonymity
We strongly suggest that members do not include their email addresses. Once that is published , your email address is available to anyone on the internet , including hackers.

All discussions and comments that contain an external URL will be automatically moved to the spam queue. No external URL pointing to a medical web site is permitted. Forum rules also indicate that you need prior moderator approval. If you are going to post an external URL, contact one of the moderators to get their approval.
Attention New Members
Your initial discussion or comment automatically is sent to a moderator's approval queue before it can be published.
There are no medical professionals on this forum side of the site. Therefore, no one is capable or permitted to provide any type of medical advice.
This includes any analysis, interpretation, or advice based on any diagnostic test

PM docs

sleeprgirlssleeprgirl Posts: 695
edited 06/11/2012 - 8:47 AM in Chronic Pain
Ok..so my first attempt with a PM doc has not gone well. It is a long story, but what I'm interested in knowing is how to pick a better one the next time.

I feel like it is going to be a stab in the dark, since I do not know any good ones.

Just looking for some personal experiences to draw information from.

Thanks everyone,



  • the PM I was sent to at all. He offered me an SCS and no meds. I just wasn't going there. I know they work fine for some folks, but it wasn't for me. I skipped the PM and went and found myself a good surgeon.
    3 level spinal fusion, L3/4, L4/5, L5/S1, November 2008. Stiff, but I can walk.
  • i maybe able to help you i found my PM doctor online on a website called URL Removed and type in pain management doctors or pain management centers and type in your state you live in and call them one by one and see if they will take you and ask them what treatments they use of they say meds then they should help you

    URL Removed. Solicitation or advertising of other companies, products, services, or web sites is not permitted. Moderator haglandc
  • it is a hit or miss proposition with pain dr's. some are liberal with pain meds and others are not, words of caution, don't say that naisd's don't work. i take vicodin but it doesn't work and i need something stronger, i need pain meds because nothing else works, do i have to sign a contract, my dose is too weak, i need a stronger dose, etc. you get the picture, all of these are red flags. when you find one, take in all test you have had, the more the better, mri,s nerve conduction test, discography, x-rays, cat scans etc. have copies of these and don't scream or be dramatic when he test your leg, butt etc. most want you to sign a contract and most start out with weaker meds and up them when they are convinced that you really have a problem. when you see one on a regular basis, don't be overly dramatic. be truthful and out front with him. i have seen 2 over 10 years, one retired and i have been with the new one for4 years. i have had no problems at all with either because i stick to the points that i wrote above.
    good luck
    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.
  • I say look for a physiatrist in your area not just a pm doc. I would call first and ask them over the phone what types of things they can do for you, before making a appointment. Also I might add while I have a great relationship with my physiatrist it didn't happen over night and took sometime to build the relationship. If i would have judged him on my first visit I would have been out of there. But because work comp sent me, I had to return a second time and so on. Over time he got to know me and me him.
  • I agree, it must take time to develop. They may see red flags in chronic patients, but I can not continue when I see those same flags. Looking at my histoy, my desire to improve, and that I am a professional, I have an expectation of certain level of sincerity. Someone to advocate for my optimal wellness.

    Fool me once, twice, three times.. but a fourth...I'm done.

    Tamtam, I agree fully with all that you posted, and when it becomes clearly unproductive(and I am using much restraint), it is time to move along...

  • I am right there with you. I have an appointment at noon with a Dr. who doesn't believe my pain level and looks at me with a blank stare when I talk to him. I am a nervous wreck about seeing him and this is all because of a botched nerve block that was his idea. Yet he makes me feel like I'm doing something wrong!!

    I may be searching again very soon, myself!

    Best wishes to you, Lisa. My heart goes out to you. I know that you aren't looking for sympathy. Neither am I. I just wish we could each find a trustworthy and trusting doctor.

  • I found luck using those online rating sites. I just kept plugging doctors in and seeing what came out. It is harder to find good reviews, but I'll tell you, people who have bad experiences tend to go out there and write about them! (I know I have, *blush*).
  • Can you ask your other doctors who they recommend?
    APROUD CANADIANveteranButNOTa doctor, my thoughts are my own
  • I wish you all the best looking for a good PM Dr. I've been to 3 over 2.8 years and have followed each of their plans for injections. Finally my 3rd Dr, and hope you don't have to go 3 like I had to find a good PM Dr. that gives good injections.

    The third one was a little exact wanting exact answers but liked her because she gave good injections and worked with me and did nerve blocks in my hip and butt and SI injections as well as facet and epidurals so she covered everything.

    I told her the Fentanyl helped my pain after a GI procedure so she's going to recommend the Fentanyl patch to my Dr. next month as my Family Dr. gives my meds and she may look after my meds from now on if my Family Dr. feels uncomfortable with Fentanyl.

    Even as an RN I have never mentioned what pain meds to give I only said the pain med only works for so many hours then when my family Dr. said hmm you're on MS Contin 4 times a day would you want to try Oxycontin as it's very strong? I said I'm a little nervous but okay. So in this case I actually agree with Jon. I'm glad I have a female PM Dr. and she asked why I needed to have 3 opinions from PM Drs and said I actually wanted a female Dr and she works close to where I live although I said nothing bad about the other two PM Drs.

    I found the PM Drs online in my area. But I wish I would have gotten into a PM Dr at a hospital just because they don't do RFA in the clinics. I hope you find the right Dr to help you. 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
  • I have a call in to my neurosurgeon. Two weeks ago, I told him that something wasn't right, and I was uncomfortable having a fourth endoscopic procedure in 7 weeks, so it will not be a surprise, and I'm so glad that I told them in advance.

    These procedures are terribly painful. I've been suffering and letting the PM doc know, and he would not talk with me about it. I was scheduled for another procedure next week, so yesterday when I called for a Rx refill, he decreased my Oxycodone from 30mg to 10mg. I asked if this was safe to do, since I've been on the drug since December. I had tried to talk with him about changing to a ER drug 2 months ago, and he kept saying that "we would talk about it during the next procedure", which has yet to happen 3 procedures later.

    He told me yesterday (through his nurse), that we could talk about using Nucynta when I came in next week for the procedure.

    How does it make sense, that when I say I'm in severe pain from 3 procedures that he decrease my meds by two-thirds, but will add another drug in 7 days. What does he expect me to do for 7 days?

    Oh, the nucynta could have potentially dangerous effect for me because I have Hashimoto's Thyroiditis and am at risk for Myxedema which is contraindicated in the use of nucynta. He has my history; will not talk with me; swayed his hand and turned and walked away when I was speaking with him about it during the last procedure. It is his responsibility to know drug interactions with disease processes, not to mention he has an obligation to not promote suffering via a pain contract, signed between two people.

    The last procedure was to dissect the scarring off of the L4 nerve root. Now, I will always have numbness in legs/feet at the L4 dermatome, because he made me feel too uncomfortable to continue going to him. His surgical skill is excellent, but I can't in a clear state of mind go to him any longer.

    I am trying to fight the good fight; I'm optimist and want to get to my optimal state of health. I'm a professional, and will not loose my dignity or humanity being treated with such indifference.

  • i think another red flag to watch out for is visiting a lot of pain doctors. i don't know why but somehow word gets out amongst drs about patients. it's like they have an esp line to each other. somehow words get out about patients who visit a lot of doctors. doctors sometimes think that is due to dr's saying there is nothing wrong with them or they are doctor shopping. i believe this is true among pain doctors. somehow, they can check your med history, your list of dr's etc. my pain ddr will check insurance info and look for meds that people take. i believe that dr's check out new patients to check their history. this has been in place for a few years now. when i went to a nose and throat guy last year, and i had a tumor which had to be removed. he asked what pain meds i have been taking? i believe he checked my history before surgery. i told him and he said i guess we won't have to write you a script you can use your pain meds after surgery. there are new procedures and laws avaiable to drs now to check your history. if they see something in your past, they will act on it.
    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.
  • oh gosh....I just feel so terrible for you Lisa and Dave..when I hear your stories. I just want to scoop you up and bring you to my little sweet PCP doctor. I have no idea where I'll be when he retires...but I think I have a few years. I just hate that you get nowhere with your doctor and he throws his hand up to you? omgosh...I'd be looking for another one too. The only thing is you really need to find a good one next time b/c if you shop around, they will see that. Aren't some PM's around you anesthesiologists?...There is a group of PM doc here who are anesth. docs...so I was wondering that b/c you may know some...but them agaiin, it can be embarrassing to go to someone you know. I wish I knew what to tell you!

  • to me i don;t think looking for a good pain dr is a red flag.i have already seen two pain drs i don't like.my 4 level fusion didn;t comeout so good.i have more pain then before surgery.i'm seeing a physiatrist this coming week, hoping this well be the dr that can help me.
  • This is your first pm doctor, right? If he is dismissing you, and not acting on your behalf to promote your health and wellbeing and pain management, seeing as it's your first one, then I don't see a problem with finding a new one. The relationship works both ways, the doctor might dismiss you, but you can also dismiss him, if he's not working for you. If it's only your first, then your history will show that. If you do find a new doctor, just be up front and honest with them, and tell them that you weren't being taken care of in a way you felt you deserved, and that it isn't just about meds, it's that the doctor continued with treatments that caused you more pain, and talked about adding a med that could potentially be dangerous to your health, and wouldn't listen when you tried to talk to him about it. I would talk to the nurse or PA, and ensure that they include that you have the other issue and your concerns to your records.
    Anyways, after only having been to one pm doc, it's not showing a history of doctor shopping, add a 2nd or 3rd in a short period of time, yes, I would be worried then. I hope that your appt with the NS goes well!!
    APROUD CANADIANveteranButNOTa doctor, my thoughts are my own
  • why when people are needing surgery you hear here people saying its better to get a second or third opinion.why would it be any different then looking for a pain dr you like.sometimes you get two bad ones in a roll.it happen to me and i don't think i'm dr shopping.
  • it may not seem dr shopping to you, but doctors that check out your history might especially with back pain. unfortunately back pan itself has become a flag for doctors. i believe a good percent of people on disability are for back pain and some back pain can't be seen. it doesn't show up on xrays or mri's. that is why having a discography is paramount in my opinion. the dye they inject diffuses through the disc and it shows a herniated disc. with respect to back surgery, my standard answer, 1/3 get better, 1/3 stay the same and 1/3 get worse. that is why one has to weigh all of the options before deciding for surgery. my last fusion made my back worse not better and i have had 3 fusions. unfortunately a fusion can destabilize your good disc above the bad one and it goes out. that happened to me.
    good luck
    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.
  • terror8396,good point.but its not right they red flag us.whats a person to do? stay with a dr thats not going to help you.anyway i do read and enjoy your posting you are very helpful.
  • It's true, doctor shopping is a red flag- but it's no reason to stay with somebody who is putting your health at risk! We are our own health advocates, remember?

    Some pain management doctors are not going to be great doctors (just like some of every type of doctor won't be- it's to be expected). It doesn't make sense to stay with a poor quality doctor for fear of being labeled a "shopper" or a "seeker." We all deserve quality care.

    Luckily, sleeprgirl is not looking for high levels of narcotics or anything out of the ordinary. She's simply looking for compassionate treatment of her pain that follows standard clinical practices. I think this is the very minimum we should all expect from our doctors.

  • I see your point, terror. I have my one year fusion visit with my NS in 4 weeks, and his PA was treating me before I saw the procedural PM doc. I think the PA will take care of me until I can find a long term doctor who will take appropriate care of me.

    I had no idea that patients had these issues, but it is good for me to understand what I am facing as I have moved into the realm of chronic pain. Actually, I have chronic pain and acute postop pain presently.

    This PM doc may not have made an incision in my back, but the dissection of adhesions is very traumatic to the tissues. My back is on fire!!!
    And I still have numb legs and feet..

    I'm taking my time to get references, but this guy just wanted to use me as a science project, without regard to the pain and suffering that he caused. My pain was just too inconvenient for him.

    Dave...I can't believe we are still dealing with these same issues. We were talking about how optimistic we were back in August about our new doctors...I'm very disappointed...(in him).

    Thanks everyone for listening and weighing in on this topic. It is a difficult and challenging road, and will only get better through discussions like these.

    Take care,


  • My first encounter with a PM doc was for a discogram, which was basically a waste of pain & time as the procedure was botched, he never prescribed meds, except for a nucynta trail. He wanted to do SCS or pain pump. My PCP was prescribing all meds.

    Post op (he was listed as my PM on record) I reached out to him, crying in pain over the phone, twice.... he never even returned my calls!

    It was the BEST thing he could have done for me, I found a spectacular PM, who has taken me on & has facilitated so many specialist visits and has taken on my well-being (all of me, not just the obvious post fusion junk), he connects the dots, so to speak!

    Lisa, I am proud of you and your decision. You are way too intelligent, bright and so well versed in your profession to be shewed away by anyone! I applaud you for enduring his tactics, lack of bedside manner and refusal to treat you as a whole. I can't say that I would have been able to stick it out as long as you have.
    Yes, he is skillful, but many others are as well. You will find "the one" who will employe not only the skillful art of PM treatments, but who also is compassionate, caring and understanding of LISA, and interested in treating you fully. So you can achieve your optimal level of well-being!

    I am sorry that you have to go through a search, but our fellow spineys have offered such great advise, I will pray that you find him/her quickly! (same for Dave!, I hope you find a great doc as well!)


  • What a lovely post, and so appreciated. This applies to every chronic pain patient as well.

    Today a neighbor came over to check on me because she sensed I was not well. Her warmth spirit so touched me, and she encouraged me to keep working hard. She had been hit by an 18 wheeler ten years ago, and has been in chronic pain since that time.

    Good to know that there are people out there that do understand chronic pain, and its multifaceted effects on the body.

    Take care,

  • Funny, but I googled my PM doc and looked on a complaint board, and saw where a woman fired my PM doc for almost identical issues. I mean this woman could have been me, except that it was a post from 2009. It really validated me, and I am confident that I made the right decision.

    Heck of a time, though..being 2 weeks postop from a procedure. Hopefully I will not have any complications.

    Thank you,

  • Thanks for the support. I am feeling better about the situation, and hopeful that I can find someone like you have found.

    Sounds like you have really found someone that will work with you, and that is wonderful.

    I haven't talked with you in a while...how are you doing???

  • I agree with Jon that discographies can be a good indicator of pain. However, with that said, those of us that have pain due to stenosis and facet problems will not get positive results on discographies.

    I don't have disc problems - yes, I have bulging discs in my cervical spine above my fusion, but the major problem is stenosis due to OA and facet issues. Luckily, my surgeon is an expert at these type of problems and handling my pain management now and probably for the next two years to come, if not longer if I have more surgery.

    So while I agree with Jon, if you have disc problems, a discography can definitely show problems. On the other hand if your problems are not disc related, there will be other tests you'll need to determine where your pain is coming from.

    Just a little bit of info for those of us with problems outside of the disc issues
  • During the endoscopic lysis of adhesions, we could see several levels well, and it did not appear that I had disc problems. I have severe scarring at, above and below my L4-5 fusion; my fusion is not yet mature, and I have severe instability in my Left SI joint with cyts...which is probably arthritic changes.

    About two-thirds of the scar tissue has been lysed by the PM doc, but I obviously can not continue on with him. Very few Doctors are experienced with this procedure, so I'm stuck with the remaining scarring unless I want to go out of state to have someone remove the rest. I just don't trust the PM doctor to resolve the scar tissue issue on the fourth procedure...and I can't take anymore. My family doesn't want me to go back to him either. I'm OK with it now.

    My problem now is that I'm left with more pain/numbness than before I began seeing him...and don't have anyone to help me for now. I'm sure that I can get some help next week.

    This is a transition time for me. I only started having pain in 4/09. Then had my fusion 11/09. I thought I would be well in 6 months, and back to my great life. The last few months have been one of redirecting my goals and focus, and coming to terms with what my new life looks like and what the future might hold. It is scary, and it is a process...I'm getting there. I've definitely lost my career; just don't want to loose my independence, too. I have some plans for starting my new life, but I have to get to a point where I have some control of the pain. I am not disillusioned into thinking that I will have minimal pain. I can live with moderate pain, but not this severe, searing pain...and that is where I need an advocate.

    I wish everyone a wonderful Saturday,

  • I believe that stenosis shows up very well on an mri. in fact on the 3 mri's that i had, stenosis shoed up and they could tell also the percentage of the closure of the disc. My mri also showed up disc infections, they were a white color. a lot of procedures will show up abnormalities which can help the pain dr along with a neurosurgeon or an orthopedic back specialist. that is why one needs to take all test results and pictures along. i believe that a lot of problems are visable now a days. in my humble opinion, if a dr does not see a problem with all of these, the chaces are that there are not physical problems. that is not to say that there are not problems, there can be when they do not show up. if you have all of these and a ddr says he sees nothing, i would get a 2nd opinion if you have problems. if more than one says they can't see anything , then there is probably not a problem. i know some of you will disagree with my last statement, but if i had all of these test and more than one dr said they could not see a problem, then i would believe them.
    by the way my name is JON not terror\
    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.
  • We are not talking about people without diagnosable problems, Jon. We are talking about people with diagnosed problems and pain who are getting treatments, and whose pain doctors are not giving them adequate pain medication.

    So let's stick with the subject at hand. Lisa is asking what the best method to seek another pain doctor is.
  • Thank you for your advice, Jon, but HB is correct in what I am needing at this stage of my fusion recovery.

    I am in the early stages of learning how to manage chronic pain from every aspect. I did not understand about the suffering of the chronic patient, as well as the difficulties in their treatment.

    Finding a way to retain my independence, bring joy back into my life; all while understanding that pain will always be there.

    Last night while looking for information concerning my rights as a chronic pain patient. Governing bodies for pain. It gives me strength to know that we do have defined rights. Joint Commission states that patients have a right to appropriate assessment and management of pain.

    The American Chronic Pain Association has what I call a "mission statement".
    Here it is:

    Manage pain step by step
    Learn what works for you
    Accomplish your goals
    Get the most out of your medical care
    Achieve the quality of life your DESERVE!!!!!!

    It says it all, for me.

    I think that I will steal it for myself:-)


  • Lisa, you are absolutely right with what you said above. YOU have the RIGHT to help with your pain. I'm so sorry you are going thru this...I think you need to have a heart to heart with your doctor or go somewhere else.
  • *HUGZ* my friend!!! I had a PM years ago, and given that experience, so far (fingers crossed), I have stayed away from them!!! My GP and NS carry my pain control meds. I am in process of having ALL my scrips through my GP, so there is less chance of interactions to the negative with other medications I am on.

    I love and agree with the "mission statement" you have posted. :) I think (me thinking) it comes from the gut as to what is right, or not. Hang in there, it will hopefully work out soon. Support *HUGZ* woman!!!

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
This discussion has been closed.
Sign In or Register to comment.