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Pain Management Doctor Ramblings

gromit12

gromit12

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Joined
Oct 31, 2011
Messages
34
Hey sorry for lurking around for so long and never posting, but had a bit of an odd experience at my doc today and was hoping I might be able to get some insight here. Was a little nervous to start a new thread also due to the fact that this question has been covered so many times.

My situation in a nutshell is I was surfing a few years ago and took a pretty serious digger and damaged my neck. Not broken and I have full mobility of my body, but after getting an MRI we realized that I have a lot of problems with my neck. My first three discs are just about gone completely and I have a bone spur on the right side of my C4 vertebrae that causes a lot of bizarre (and extremely uncomfortable) nerve pain that usually round the day out with a dull ache that affects sleep and is frankly pretty miserable.

I had been going to an orthopedic center to get medications (generally Norco) and they didn't really have a problem prescribing me 90 for 30 days. It's not a lot (comparatively to some people I see on here who go to pain specialists), but I really don't screw around with it so it's an ample amount really.

Here's the kicker though, I'm 21.

The bizarre part was when they were viewing my MRI of my neck they know that I have serious problems and they even said "your neck looks like it belongs to a 70 year old"

Despite this, they keep trying to say I shouldn't be depending on pills, which I agree to to a point, but there are some days where I just can't take it. My condition hasn't really progressed to need surgery (and their of course wary to because of my age). Also, I know pain is all relative really, but in a month, the pain is consuming my thoughts %75 of the time.

I went in to the doc today for a follow up visit and it started out weird. They were passing out clip boards to everyone that had some really personal questions about family drug abuse, how I go about taking RX'd meds, and some other things along those lines. Also included was a contract having to do with doctor shopping and the like. I've been coming to this place for a year and never had to sign or deal with anything like this, but I guess it's to be expected.

When the doctor came in, she started recommending more MRI's (which I'm starting to get sick of, they really don't need anymore data) and then tells me I need to give her a urine sample. I was clear with her before that I hadn't taken a norco in close to 5 days as I wasn't having any serious pain (just to cover the base of them checking out your dosage) and I smoked pot like 3 weeks ago, which is rare for me, but of course they decided to do the test now.

Sorry if I'm rambling, but before today, I never had a problem going in, getting a script and going on with my life. Today however, it felt like the DEA were like IN the building. They were being so strange.

I guess the point of this is, should I look for a new doctor? All she gave me were 10 Nucynta which is really doing nothing other than making me feel kinda loopy, and aside from that even with insurance it's bloody expensive.

Any advice? Thanks for the help guys. Sorry if that was a long ramble, still kinda flustered, and in pain :(
 
Hi gromit12, sounds rough I wouldn't have signed the paperwork or provided a sample unless I knew exactly the reason for the sample ad what they are testing for and had read and fully understood the paper.

If you don't mind me asking what country do you live in, I am from the UK
 
I have lots of friends who see pain management doctors. These forms and tests are standard (I live in Southeast U.S.) around here, it's common for pain docs to divorce patients from time to time. I know several people who have been divorced for having inadequate levels of the prescribed drug in their urine.

The DEA monitors pain doctors more heavily than anyone as they prescribe large amounts of narcotics. 1 friend's pain doc has an ex-DEA agent working in his office (no idea if that's legal...)
 
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Hey ATM - I'm located in the Western US. The whole evaluating the contract more thoroughly before signing sort of hit me in hindsight, of course.

Fullbird - That's pretty bizarre. The strange thing is this place technically isn't a pain management place, or at least I didn't think so because there was never this amount of scrutiny, but I guess they must've gotten in trouble or something because today it felt like I got in trouble in middle school. So awkward.
 
90 Norco for more than a month or two is likely from a pain doc. Also, usually don't go to Norco over Lortab or something similar unless doc expects you to take meds on regular basis or long time to help your liver/stomach, again likely pain doc your seeing.

http://www.painmed.org/
National pain doc association
Somewhere on site says something like expected chronic problems for extended period of time or something for someone to see a pain doc. Again, likely pain doc your seeing.

Expect similar treatment from any doctor giving you a sizable narcotic for an extended period of time.
 
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Yeah sorry our medical system is totally different in the UK, the only time I've ever heard of people having to give urine tests are when they are on detox programs for Heroin almost exclusively.

The US system is a mystery to me
 
Fullbird - Yeah, you're probably right. I would just think that with my injury as it is they wouldn't be telling me not to depend on pain medication or would make attempts to taper me off by making it uncomfortable to request refills. The place is really strange and disorganized.

ATM - It baffles me too.
 
Also, I don't know if this against the rules, but does anyone have advice on how to find pain management docs?

In addition, if I were to get ahold of a new doc soon, would that be considered doctor shopping? I technically don't have another appt. at my original place and the Nucyna script she gave me was just for 10 pills to try.

So much gray area 8(
 
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Gromit, I'm really sorry to hear about your situation.. I hope you find a decent pain management doctor. We can't help with doctor shopping but trying to find a good doctor isn't that unless you're hopping from one to the next to get prescriptions.. Changing your doctor once wouldn't count as that in my eyes, if you're not getting the treatment you need then it's entirely reasonable that you get another opinion.

There is a pain management megathread in Other Drugs here which might be of some help to you..

If your pain level means you need meds then you need meds, whatever your age. Have you tried non-opioid things? Neuropathic pain from nerve compression/irritation often responds well to gabapentin/pregabalin or amitriptyline, and NSAIDS etc can help too. There are also things like nerve blocks and TENS machines which help some people. Sometimes people do need strong opioids though, that is what they are prescribed for after all. Good luck <3
 
Effie - Thanks for sharing the megathread! I'll take a look through it and see if there's anything for me in there.

They have put me on Gabapentin in the past, which made some of the nerve pain symptoms subside but also made me have that feeling all day like I was coming off of some kind of upper (sweating, anxious, etc.) I also know that it takes a while for it to process in your system but those side effects also didn't really go away. It also made my thinking really cloudy which was frustrating as I'm kind of a big talker, lol.

It's tough because I understand why there are so many restrictions on strong opioid medications, but on the whole to me they're effective because the side effects are straight forward and they're extremely effective in treating the kind of pain I experience. Also it's properties that are considered "recreational" are tolerable, and pleasant compared to other drugs I've been prescribed (Tramadol made me feel literally like an insane person).

Thanks for the help guys.
 
You can legally change your doctor as often as you like. "Doctor shopping" is a case of really poor terminology. It means going to multiple doctors in order to get multiple prescriptions. When you change doctors you need to tell your NEW doctor your previous history, including prescriptions, and authorize them to access your previous medical records. As long as you are up front and honest, you are very unlikely to run into legal trouble. You should make sure you only have active narcotic prescriptions from ONE doctor, and be sure to bring your pills with you to a prospective new doctor, as well as canceling any refills that might exist under your old docs name.

I live in Canada, where things aren't nearly so batcrap crazy as they are in the US, and yet every time I see a doctor, even a psychiatrist, I ask them to forward the diagnosis to my GP, and I have my GP write ALL of my meds. Pain meds, psych meds, antibiotics, whatever. Not only can I not be accused of doing anything underhanded, but between my doctor and my pharmacist it's virtually impossible that I ever have a medication conflict. Also, while specialists come and go, I've been with my GP for over 20 years so there is a lot of trust there.
 
Thanks SPC. I currently have no active prescriptions from my previous doctor, and no current refills. All she gave me were 10 Nucynta which should have already been used by now (didn't like it, so I didn't finish the script)

So as I understand it, it's considered doctor shopping if you have two active prescriptions from two doctors simultaneously, got it. Still, sooo much grey area in the US.

Thanks for the advice concerning the GP as well.
 
Hey there, Gromit. Hope things are going well for you. I have a little experience with PM docs. I know they will need you to bring all your records in (MRI, nerve tests, etc.) I had to sign a contract too. It basically said that I will only go to one doc and that I may be asked to bring my script in at any time so they could count the pills.

That sounds pretty crazy with all those people there. The only thing I could think of is maybe they're students. Weird though!

Along with meds, I used to get the occasional trigger point injection. They help some. The therapies I got didn't seem to help (cracking and cold therapy with electro something =) ), but I did want to try traction. You can buy a home traction unit.

I know what you're going through sucks. I've been there. Let us know how everything works out. =)
 
Hey EvilKitty - yeah I find traction to be pretty helpful as well. Luckily when I had this last visit with my doctor I got a CD copy of the MRI and the report.

Are you located in the US?
 
This may seem like an odd suggestion, but it's what I did to find my pain management doctor and he's great. I'm also 21, but this doctor is really understanding and has me on the right medication. I get 120 percocets/month.

Pain Management is a fellowship in medicine, meaning you have to do residency in something else before continuing into PM. The "pre-pain management" fields are anesthesiology, neurology, psychiatry (I have no idea how psychiatry is related to PM), and physical medicine and rehab.

I know for my condition, it was a lot of somatic pain that could be combatted with x-ray guided injections into various aspects of my spine, so I opted for an anesthesiologist after reading that they're usually the best for my type of condition.

You had a traumatic accident; I would maybe think of trying to find a PM doc who is also a physicial medicine and rehab physician. The doctor, through his 4 years of training before pain management, will likely be more empathetic to your condition and maybe even offer some great physical therapy, as to lessen the need for narcotics.

Dunno if this really helps, but it's worth investigating. You're not doctor shopping if you're simply discontinuing from one doctor and going to another. I did this with my GP b/c he was a complete incompetent asshole.
 
GABAking said:
You're not doctor shopping if you're simply discontinuing from one doctor and going to another. I did this with my GP b/c he was a complete incompetent asshole.
Click to expand...

This is correct - you're totally within your rights as a patient / individual to seek treatment from a different doctor due to a shortcoming with your current treatment.

Doctor shopping's legal definition is actively going to multiple doctors to get Rx's for the same drugs for the same condition. <- this leads to 3-4 oxy scripts or whatever. THAT is illegal.

Good luck getting yourself sorted out!
 
Thanks for all the help on this issue guys. I have been seeing a GREAT physical therapist since a little before I started this thread and he helps quite a bit to keep inflammation down (which causes most of my day-long pain) and has a great understanding of my condition. He has personally referred me to a PM doctor who is apparently a friend of his. I made sure to have him speak with the Dr. so there's no confusion as to what's wrong with me, to know that I'm actively working on a maintenance program, and to know that my condition is mostly progressive in nature. I see him in about a week.

Thanks everyone. Here's to hoping.
 
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