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Frustrating PM appointment

manaleriemmanalerie Posts: 550
edited 06/11/2012 - 7:22 AM in Pain Management
So I finally got in to see the Pain Management doctor on Tuesday. I have to say I was very disappointed. The guy spoke so fast that I couldn't even finish answering one question, before he started the next.

After the exam, he told me he wants me to go back to physical therapy for "rigorous exercise"

I have arthritis, basically a 27 year old with the back of a 40 year old.

He said that he would like to give me an epidural, and that is all that he can do for me.

I asked him when I should come back to see him again, and he said that I don't need to. Except for the epidural, there is no need for me to see him.


How then, is he managing my pain??? I expected him to sit down with me, work out a plan of attack so to speak. I expected a support system, follow up visits etc.

Anyone else think this is strange?


  • with paul. run do not walk to another pm doc. I have heard of lots of PMs out there that only do injections for lots of money. From my experience I can tell you that the steroids are not normally a long term solution. Keep looking until you find a doc that is commited to helping you manage your pain no matter what it takes. Good luck and keep us posted.
  • I heard that they make a lot more money for injections than for meds. But I don't need meds. I am getting meds from my Neurologist. We're still trying to find the right adjustment, but that part is covered.

    I guess I just expected more from a "Pain Management" doctor. You know, like for him to help me MANAGE my pain???? I'm not sure there are any other PM's in my city. I will have to look.

    I think the closest PM would be in one of the other big cities. I heard Boston has good PM clinics, but thats a good hour drive through nasty traffic. Anyone who has ever had the pleasure of visiting Boston knows what traffic is like!!! lol
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  • heard of doctor shopping? This guy is patient shopping. He's in it for the money. Find another if possible. Good luck.
  • I guess I'm confused here...

    You said that you don't need him to prescribe you meds because your NS is taking care of that, correct? And you also stated that this PM doc is willing to give you injections and wants to start you on PT.

    So I guess what I'm wondering then is what do you want or expect from a PM doctor? Did you ask him what kind of treatment plan he would advise for your condition(s)? I assume your NS does MRI's or other diagnostic tests as necessary for him to see what's going on, yes?

    Don't get me wrong-I'm not saying he's doctor of the year, but if you're being medicated and this guy is offering you other things to go along with your meds, such as injections and PT, then I guess I don't understand what else you're looking for?

    I agree that some PM's ARE only looking to make money off injections, and yes there are PM's that don't provide medications, which to me seems to be an oxymoron type thing.

    Maybe, because I haven't read your other posts, I'm missing something, but I just don't understand how you want more than what your NS/PM combined are trying to do for you (aside from eliminating your pain...we'd ALL love that for sure!) Could you clarify this some so that I can understand more and maybe offer you some advice that might be helpful for you?

    I hope you feel better very soon!

    Take care of you... :)
  • I so can appreciate what your saying, and the others here too. I had a fusion at L4 L5 with hardware almost two years ago.. it failed miserably to say the least. I have had ten times the pain since. My PM didn't want to do anything other then the epidural injections, I was in for them almost monthly. I didn't see the point to thins cause it only lasted a few days to a week at best for me. At the start he had me on Vicodin, the 750's, and gradually he brought me down to the 500's. The higher dose hardly took the edge off so I was pretty upset with his thinking that he didn't want to create an addict. People in chronic pain DO NOT typically become addicted in the same sense as street drugs-as they don't use their meds for the "high" but for the "pain". He told me that I had to "find a way to deal with the pain" but gave me no other options, didn't discuss a plan of action or give me any advice on how to do that. His bedside manner really stunk too. But, I stayed with him for almost a year hoping he would come up with something that worked for me. The last time I saw him was when I had injections aggggain. This time my boyfriend went in with me and asked himself what are you going to do ??? She cant hardly walk from the living room to the bedroom. He was told that all he could do is the injections when it became unbearable... provided he was dong them that day in the surgery center, and had an opening. What a crock of crap !!

    I now have a new PM who is so awesome. He is very personable, talks to me, asks lots of questions, and does a lot of hands-on diagnosing (checks out every vertebra and disk at each visit). He found a bulging disk on my very first visit to him and started me on a low dose of Kaiden (a long acting form of morphine) which takes the edge off most of the day. I still find its hard to move around, but I have hope now as we have discussed other options for me. He really has a plan for me and I am so happy for the first time in a year that someone isn't blowing smoke up my skirt.

    I had some facet joint injections at that level above my fusion, but that didnt help much at all so now they are talking about RF something, I have to do my homework on that yet. If that dont work then there is talk of a pain pump, again more homework.

    I strongly suggest that you make some appointments to meet these dr.'s in your area, interview THEM. See if they meet YOUR standards for care providers. You/your insurance are paying for it, get your moneys worth. I truly hope that you find whats best for you. I hope that whatever treatment is discussed and followed that it works and your feeling 100% soon. Take Care.

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  • What struck me while reading Amanda's original topic post was that she has run across an honest doctor who probably is super busy and consequently has few people skills and a lousy bedside manor. Most doctors in my experience look at the complaints, symptoms, test results and opinions of other doctors presented by a new patient then make a decision based on his or her experience for the best way to proceed. This particular doctor has poor communication skills or he would have explained to her he evidently didn't think she needed a long term pain management plan. Its a shame he didn't even ask what Amanda wanted or expected from him. If he were in fact one of "those" doctors who's only in it for the money she would have unnecessary appointments scheduled for a series of epidurals and facet injections, myelograms and a pocket full of prescriptions resulting in an on going dependence on medical care. My view is she was fortunate to find a good one. Of course there are always second opinions and third opinions to go for. Anyone looking for on going care from a doctor is sure to find it.

    If I come across as arrogant or condescending I apologise. I have 4 decades of dealing with doctors and nurses and clinics and hospitals because of my back. Really good doctors, especially pain management specialists are rare as hens teeth. Finding a good honest one is a blessing.

  • It's true that pm docs pick and choose what they want to do; they are not all the same. If you look for a new one, look him/her up on the internet and find out their treatment philosophies, what they treat, procedures, and sometimes they list what they prescribe. Some have physical therapy in their offices. And of course there are the ones that just do injections and a motrin if your lucky.
    I'm saying that strictly from my experiences with ESI's because they all failed. I'm sure one day they want to try; I've already maxed out 6 months ago, and am currently still trying to recover from a TLIF and unrelenting sciatica. It's been 11 weeks and I have a long way to go. If pain mgt asks me to try another whenever, I will be compliant. I want them to see that I am doing everything to help myself, and not rely soly rely on meds alone. They wanted me to consult a neurosurgeon, and I did. He said things where at the point that I need surgery, and I did it. I was told if it didn't take the pain away, that he would try a stimulator trial.
    I had one earlier this year, and I seem to be very susceptible to spinal headaches caused by spinal fluid leaking. Well, we'll see, I won't cross that bridge until I see it in the horizon. Hopefully not.

    Find someone with your needs and one that will LISTEN. I was so at ease; I told them everything, and the doctor was wonderful. The staff is sweet to me and I like where I'm at.

    One way you can tell how an office is, is when you walk in. Does it feel tense, rushed. If so, get out while you can. Take care
  • Let me try to explain it

    Primary says I need surgery go to NS. Refuses to treat me for pain any longer. Told me to go to PM.

    Went to PT, treated like I had the plague

    Went to Neuro, said I don't need surgery, gave me meds. Also said that PM would take over treatment.

    Went to PM, told I don't need surgery and told me to go back to PT, and that I don't need to see him again, unless I'd like and epidural.

    Went to NS, told no surgery, and that primary doctor should be treating my pain. But since my primary has already refused to treat my back, he will send him a letter, explaining that I am not a candidate for surgery.

    Still getting meds from Neuro, and happy with that.

    Yes, he did in fact offer help, just not what I expected. He is sending me back to my original PT, who as I said before, treated me like I had the plague. They were afraid to touch me, and would only do ultrasound. My frustration, comes from the fact that the PM said there was nothing else he could do to help me. I was under the impression that he would be taking over all aspects of my pain, both physical and mental. I was under the impression that a PM would want to see me regularly, but he said I should only come back if I want the epidural. Since they specialize in pain management, I guess I was looking for, well, management. A plan of action. I ASSumed that he would take over.

    Does that make sense? I am happy to go to PT, and to continue being treated by my neuro. I guess I just expected more from the PM is all. I just don't see how he is "managing" pain, if he doesn't want to see me.
  • I don't find you to come across as anything but honest. You do make a good point. The thought did occur to me, that if this guy were trying to get money, he would have booked hundreds of appointments with me etc. But that's what I expected from him. I expected him to take over my pain management. That is what he does right?

    I was very frustrated with how fast he rushed through my appointment. He was asking me questions, and before I could finish the answer, he started with the next question. He was also asking questions while he was doing my exam. I couldn't comprehend what he was asking, because being manipulated into these positions was excruciating. That made him agitated, and he repeated his questions with what seemed to me like anger. I may have misinterpreted his tone, but that's honestly how I felt. And the look on the nurses face, as I was crying, told me she felt the same way.

    He also implied that since I stay home with my son, that I am not "moving enough" which is worsening my pain. That may be true. I also take offense to such implications, so that may have blurred my judgment against him. I am certainly not laying around all day. Even if my pain levels are at a full blown 10, I have no choice but to push through it. I have to take care of my son. There is no one else to do so, and no one else to help. My husband works 12-16 hour days, and I feel horrible to ask him for help when he gets home. Again, maybe I just read him wrong, but that's the impression I got.
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