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pain management change?

southsider81ssouthsider81 Posts: 6
edited 09/10/2013 - 11:54 AM in Pain Management
My question is: when is it time to seek the care of a new pain doctor if you believe they're either not qualified or not interested in helping you anymore than they are currently?

Basically, the nurse pract. does the medication management and the main Dr. does the procedures. He's a wonderful man and the nurse isn't so much a great person. Every meeting with her is asking me questions off a questionairre that ask me things like "how much do you feel the medication is helping treat your pain". I usually respond with "It depends on the day. On good days it seems like the meds lower my pain to roughly a 6 or less. On bad days my pain still stays at roughly an 8 or 9." She will ask me to give her a number like a robot until I tell her I don't know how to answer that. There are a ton more issues that I've had with her such as: she wrote down that the meds aren't helping, according to me, that the epidurals have worked great, even though they haven't at all, and has me down for 3 green stickers to which I have no clue what I did. They never informed me of anything I'd done wrong, I've never failed a drug test, etc.

In order to try to alleviate my pain I've also tried these alternative methods:

-physical therapy
-ice packs
-hot baths w/ magnesium,

My PCP, psychiatrist, and family all believe it's a logical idea but she does not. I just don't understand.

So I'm trying to start school and she put me on a wild goose chase. She said to see a pain psych a bit back. I called him several times and left messages every time. He got back to me 3 weeks after the first call and informed me that the nurse practitioner said not to see him. I said ok, she must have talked to my dr.'s . I made an appointment, she treated it like she didn't know me and she went to end it and I asked her about the short acting medication(which this is all about. I'm on 75mc/g fentanyl and that works wonderfully. I just get breakthrough pain occassionally and was asking for a short acting med which she kept refusing.) She said "did you see the pain psych?" I told her what he told me. She didn't seem to believe me. She told me to try again, get the radiofrequency ablation done on my neck, and go from there. I tried to contact the pain psych and still never got any response. I had my procedure done, asked ahead of time to talk to the main Dr. about my insatisfaction, and also let the nursing staff know to let the nurse pract. know I was doing so as a professional courtesy.

I had my procedure, doc always tells me how well I do w/o an anesthetic, and looks at my chart after comes into the room to talk and tells me: 1) I haven't seen the pain psych 2) I have 3 green dots 3) I said the meds aren't working 4) I have severe anxiety.

I told him about the pain psych dilemma, asked about the 3 green dots, told him the meds are working and what I tell her, and told him my anxiety is from feeling unable to control my breakthrough pain. The green dots were b/c of a "failed drug test" which was the 1st one I ever took in which I informed the nurse before I even knew of the test that I had found an old oxycodone from my previous dr. and took it yesterday bc of such pain. She said "I'm not the cops, don't worry about it, but don't make it a habit". the other 2 dots I still don't know of.

So the dr. told me that he will intervene but to still see the pain psych. I said ok, he called in an rx for norco and I went home. So, the norco ran out, later than it should have lasted, I called in a refill request and they're treating me like the Dr. never wrote an rx for it, that I'd never tried to call the pain psych, etc.

So I don't know what to do. The dr. is great, and treats me fairly, and also says that sometimes people like me get treated wrongly by accident by misunderstanding, and he will take care of it. I thanked him and told him whatever they need to make them feel comfortable with my safe use of my medications I will provide. I just hate that they are so polar opposite and though I really like him, I don't know if I should just find a new pain managment facility. I don't think he talked to them yet, I know in the end I have him on my side, but his time is hard to come by and I don't want to deal with all this in the meanwhile. Plus if I find a new pain dr. who's to say my record according to her won't give me a bad rap? She's never been interested in my case and I knew it the day that I offered her a copy of my pain journal which I had been keeping for 2+ years.

Any ideas, suggestions, etc. is greatly appreciated.



  • I am really confused and have question for you. I have to switch over to my laptop and will be back in a bit.
  • Let me see if I am understanding you.........you see a nurse practioner for your med management, and you see the PM doctor for procedures? Right? The NP asks you how the meds are working and you are telling her at their best they are giving you relief down to a '6' on the pain scale, and on the worst days, your pain levels are '8-9' with meds?
    THAT is why she is saying that the meds aren't working for you- from your own reporting, with meds, it is not giving you any relief .....you are answering her questions, which are quite normal questions to be asked from a pain management standpoint, and you are reporting pain levels that are high for unmedicated patients.....
    One of the biggest problems is patients going in , complaining of a 9-10 on the pain scale, believing that reporting higher pain levels will equal a higher quantity of meds or a stronger opiate.....Patients who are truly at an 8-9 on a pain scale can not function, can not carry on a conversation, can not think clearly, let alone concentrate on a conversation.......and you are trying to tell her that your pain levels medicated are that high. So she is only reporting what you are telling her....and that is that the medications are ineffective.
    If you were told to see the psych. doctor, then you should have done it, no matter what you were told by him. He then could have/should have sent back a report to your PM doctor, and to your NP regarding the visit.
    Now, you go and tell the main PM doctor exactly the opposite of what you are telling the NP- that the meds are working well, the injections aren't helping but you are still having them, and then you took an old medication? Yes, you did in fact fail the urine test, at least this last one and if I were you, I would be asking for copies of all of the ones that you have taken since you have three failed tests....NO MATTER what happens, you should NEVER, ever take any medication not CURRENTLY part of your treatment program.
    As far as the other modalities go, you said you tried them, but are you currently still using them? Every day. every flare up? Because they will go further in treating your flare ups than relying on yet more medication.
    Since the NP is the one managing your meds, you really should not have gotten the prescription for Norco from the PM doctor. Especially since she told you no to them, at least until you complied with her instructions.
    I see several areas where the problems you are having with her are in fact, more on your part than on hers....you are non compliant, - in that you were told twice to see the pain psych, and you have yet to do so, you are complaining that even with medications that your pain is out of control, therefore making her continuing to give you medications not reasonable. Opiates are only supposed to be used to treat chronic pain when there is a benefit to the patient- ie improved functioning and activities of daily living....you are telling her that things are exactly the opposite.......
    And on top of everything else, you have three failed tests, and took meds no longer prescribed to you- a direct and clear violation of your contract. You are lucky that you weren't dismissed from their practice at this point...doing that in most PM offices would have had you dismissed the very first time you failed a test...
    Here is a link to getting chronic pain treated- you might want to read it..........
  • Sandi, I think he said that he failed the very first drug test..not the last. And if the NP and actual DR. never speak to each other how are they supposed to really know what's going on? I have the same situation with the Dr. doing Procedures and at regular appts. I see the NP... I only get to talk to the Dr. if I insist at a procedure...and that hardly ever happens. I love the Dr. but the NP's always seem to be in a hurry and don't really want to listen... so, I understand what he's saying...
  • Just in my personal opinion, treating NP's like they are just employees of the doctor isn't really a good idea (I'm not saying anyone is doing this). NP's go through a LOT of training to get where they are. I see an NP for my regular medication management and have only met the Dr. 2x. I personally LOVE my NP. She will ask me how I'm feeling at that exact moment, what my pain has been like in the past since last appointment, has anything changed, any new health issues, any new medications (not pain related, just health related) We even tend to chit chat somewhat. She never rushes me and will take the time to answer all of my questions, even if they are not pain related. One time she even checked my Lymph nodes because they looked swollen).

    I just think they deserve more respect than people tend to give them. Like I said, just my two cents.
  • sandisandi Posts: 6,342
    edited 09/12/2013 - 9:49 AM
    He said he has three 'green dots', and since the green dot apparently means that he failed a drug test, then it would appear that all three dots means that he has in fact, failed three tests......once may be because he took an old med, but the reasons for the other two are unknown, it could be for something other than what he is prescribed showed up- or not enough of his prescribed meds showed up, or illicit substances- whatever the cause of the failed tests, the fact that there are three is a big problem..that, the meds he is taking don't seem to be of benefit if he is reporting pain levels at the scale he is stating in his original post....
    My experience with NP has been much different than yours, in my experience, NP work twice as hard as the doctors seem to , and often spend far more time with a patient than most doctors do, and tend to be more careful and thorough , probably because of what they have to go through to get liscensed.
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