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  • BDD Moderators: Keif’ Richards

Primary Care Physician Refusing To Treat Extreme Pain

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Thanatos

Thanatos

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This is more of an opinion/ suggestion thread.
Today I went in to an internalist, and was refused to have my pain treated or be 'fired' from her care if I didnt stop insisting on how I am in pain. I'm going into my 4 rehab stint for my knees already having my hoffas pad removed along with many bone chips and cartillage last year. I've been accurately diagnosed with a torn abdominal wall and groin along with a possible meniscus tear and definite high grade patellar tendon strain from another ramd doctor in the same clinic. I was threaded with being fired, going to the er, or submitting to another ct scan, bloodworm and a ua. Which were completely unneceasary. I didn't even ask for opiates, even the suggestion of a strong NSAID (even though i have been prescribed everything between cyclobenzerine tk vast amounts of oxycodone in the past) prompted this hag to threats and termination when I can't even walk without a rise in blood pressure/pain induced fever. I have since changed my care to an orthopod, but I need my pain to be managed. And find a gp willing to understand my well docented history of chronic pain.
What are your thoughts and experience similar to this? I am infuriated and left without any form of aim management, and I start my PT tomorrow with no analgesic on my side. Help me find a constructive solution BL friends!
 
But how do I find one that is caring without excessive office visits? My insurance can only cover so much, considering I also have a psychiatrist and need physical therapy. I scheduled an appointment with a trusted sports medicine specialist (injury occurred during strenuous exercise) but I have no idea how I would go about finding a doctor without a consultation costinge yet another $100 co-pay. I can't afford a pain management specialist, so I need an internalist to at least help me with some meloxicam if I can't get a monthly supply of hydros. I can't take tramadol due to its stimulating effects, I have extra pyramidal symptoms from anti-psychotics I used as off label therapy for insomnia.

Would 4 years of constant pain and physical therapy be considered chronic pain? I understand I am in the acute phase- under 3 weeks since injury- of my current ailment.
 
anything longer than 3 months is considered chronic, but some doctors don't consider it chronic enough until about 1 year after injuries...
 
Regardless of the pain specialist, my insurance requires me to have a primary physician to be covered. I'm only 20, would a PM specialist be likely to accept me into his/her care, given my history of trauma and surgery? I also have been diagnosed with moderate-severe neuropathy. I always hear of middle aged people going to pain management instead of a fit 20 year old in his prime.

Please feel free to post experiences similar or different, I welcome any addition to the thread, as long as its constructive.

My knee injuries date back at least 5 years, first PT order was 3 years ago. I get one at least once a year.

Please ignore the spelling errors, I am using an itouch right now.
 
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And you have to understand that doctors are under siege in the states by the DEA and are becoming more and more hesitant to prescribe anything beyond like Ultram, especially with Hydrocodone being moved from a CIII rating up to CII which means that there are no refills possible...=(

Most internists, family care guys etc refer patients to PM clinics so they avoid liability.

And with a PM Clinic, you really want to present yourself as someone who has tried (and failed) in doing all the therapy, stretching/yoga or whatever to improve your situation. I know from my 2nd fusion surgery, I had to try all sorts of stuff to improve my condition without pain meds, and when that failed I was finally prescribed meds and the doctors pursued the issue determining the extent of my back's damage.

good luck bro
 
Ask your ortho for a referral to a pain specialist. You have legitimate pain stemming from physical injuries, you're not going to be turned down for an examination.
 
As stated earlier, I've spent at least 3 months a year in pt for the last 4 years. Today's physician refused to refer me on 'religious' grounds. This seems like a violation of the hypocritical oath or even descrimination/malpractice but I am not a man of law. Hydrocodone will be moved to schedule II? I was completely unaware. I can't take tramadol, my seizure threshold is too low to risk it, but my 5/500 vicodins dont even touch the pain. What would be a common treatment plan for someone with my extensive history of surgery-trauma and neuropathy? The web is full of useless garbage on the subject.

Morphling said:
Ask your ortho for a referral to a pain specialist. You have legitimate pain stemming from physical injuries, you're not going to be turned down for an examination.
Click to expand...

I'm not informed on the subject very well, as I can't find many reputable sources on the web. Should I ask for this referral once my PT has been completed and the acute injury phase is over? I will most likely live in pain for years to come due to missing a large part of my knee and substantial neurothropic pain. I'd love any advice, thanks to all that have posted so far!
 
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Can a PM specialist be designated as my primary care physician? I rarely get sick, on average once every two years.

I am tapering my psychiatric medication and will soon leave my psychiatrist, thus leaving me with no treatment for neuropathy and off label pain management. Any knowledge or experience is worth more than you know.
 
Pm dr treat pain. They are usually specialists. My pm will not even prescribe a antibiotic with out me making another appt to see the other treating partner who treats different conditions. Its weird but that's my experience.
 
But will the pain doctor be able to refer me to a compassionate internal medicine specialist? I need a PCP for my insurance, but it's not pressing or needed within the next week or so.

But to clarify, I am eligible for chronic pain treatment, regardless of my age, considering my nerve pain and history of joint/muscle surgeries and tears?

What type of medication could I possibly prescribed to since I have been on and of opiods for about 3-4 years? I can't afford OxyContin and there is no extended release hydrocodone product in the US.
 
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Methadone is very cheap. Fentanyl is actually pretty cheap as well. Morphine has also been around a while and is reasonable. There are generics of hydromorphone, oxymorphone, morphine, methadone, hydrocodone, and fentanyl.
 
How commonly is methadone prescribed? I do not have absolutely debilitating pain, but in do not need, and cant tak a long term anti anflamiory either. So it seems methadone or a generic CR morphine- morpholone product would br best for constant moderate chronic pain? I apologize for my ignorance, I've never had much reason to keep up with opiods other than those that I have been prescribed and the basic pharmacology. Never the actual prescribing of the stronger or controlled release agents.
I am going to see the sports medicine physician for my acute injuries that will be supervising my physical therapy today. Should I just ask him for a referal to a PM specialist or find one in my insurance network by myself? Being so young, I have very little experience with choosing my physicians up until this point in my life.
 
I'm really sorry for your possition, entheo and I'm glad people here can be of some help - but do remember this isn't a medical forum, or a medicolegal forum.. I have no experience in choosing physicians either (I'm from the UK, our whole set-up is different) but if you trust your sports medicine physician then asking them for a referral could be a good plan. The best person to get advice from about which opioid (or non-opioid, especially given your nerve pain) is best for your particular pain is a good pain management doctor.

I would merge this with the pain management megathread (*here*) but the posts merge in date order and would get lost with posts already in that thread.. I would take a look though.

Neuropathic (nerve-related) pain often responds best to non-opioid drugs such as gabapentin/pregabalin/amitriptyline - I presume you've tried these as you have such an extensive history, but thought it was worth a mention, along with nerve blocks / steroid injections etc..

Good luck <3

(Ps I've merged your double posts, could you use the edit button next time? Thanks :) )
 
Steroid injections are out of the question as they degrade joint integrity and I've already had multiple cortisone shots in my knees, along with artificial lubrication. Yes I have tried gabapentin, but it blurred my vision so badly along with limited effectiveness that I am no longer scripted it. Opiods have always worked best for me, even in sub euphoric doses. Even soma only takes away the pain enough when combined with tramadol or my clonazepam(high dose)
 
^ fair enough, yeah the risk:benefit ratio for steroid injections can be pretty abysmal especially when you're dealing with joint erosions. I'm sorry gabapentin didn't work out; you could try pregabalin but I understand if you are reluctant, especially as you know opioids do work for you.

In the UK, age is no barrier to seeing a pain specialist.. but then in the UK money doesn't come into the equation either, and the whole structure of our healthcare is different so I don't know what to advise you :\ but I would have thought if you have legitimate pain, and the test results to back up your diagnoses, you should be able to be treated by a PM specialist?

A recent systematic review found no overall difference in efficacy between morphine, oxycodone and methadone (abstract here) although individuals do vary in their responses to opioids so different drugs suit different people; there is also a difference in tolerance to side effects. Morphine is definitely worth a try and is considered the "gold standard" by many, but methadone is certainly another option and is gaining popularity over here.
 
the only way i see a primary physician refusing to treat you with extreme pain is for reason: A) he is referring you, or basically telling you to go to a pain management doctor B) You have a history of drug abuse, or broke narcotic agreement in the past, or Perhaps he is treating your pain, but maybe not the way YOU want to be treated? (for example my primary gave me Cymbalta for extreme pain 2 years ago) i WAS PISSED, perhaps??
 
Not all doctors treat pain the same way........there are doctors that will give you anything under the sun for pain & others that will give you Tramadol & maybe a muscle relaxant & tell you to go on your mary way...........just stop going to the prick doctor you have now & find a new one. Finding a doctor willing to prescribe you opiates for severe pain is like a puzzle.
 
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