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#684787 - 04/16/08 10:40 PM
What to expect at Pain Management first appointment?
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LBJ
Pooh-Bah
Registered: 11/28/04
Posts: 1245
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I would really love to hear as much feedback as possible from anyone who has experience in Pain Management programs. I have some specific questions, but any personal experiences, feedback or advice would be greatly appreciated at this point. Thank you in advance for your contribution to this thread. 
After a long and (literally) painful search, I have finally found a good PM doc and I'm actually going in to my first major appointment tomorrow. After suffering with chronic pain for over 7 years and being under-treated I am actually a bit nervous about tomorrow and I want to make sure that I do everything right and get the most effective treatment that I possibly can as it is not only expensive (even with insurance) but it is also difficult to get in (there was a waiting list that I've been on for a month and getting on the waiting list requires some "hoop-jumping").
There were about 30 pages of paperwork to fill out before the appointment (no joke!) and of course a significant portion of this is the contract itself. I am optimistically hoping that it will be a contract that I can follow  , but just out of curiosity; what ways besides that urine test (yep, it's in the contract  ) do they have to ensure that I'm following the prescribed regimen? I'm not trying to buck the system, but I'm not used to having my life so closely scrutinized and monitored and I'm just curious what to expect, especially after self-medicating for so long.
Do they ever ask you to bring in your current supply of meds to be counted or anything? If so, how often do they decide to do such a thing? (I realize this is totally subjective, but I'm still curious of your experiences).
Also, is there a good chance that they will actually prescibe medication on this first visit or will they be needing to do bloodwork or tests or something first? This first appointment is 2 hours and they said that they wouldn't need to see me again for another month. The doctor has already reviewed my medical records (which include a very recent physical) and "approved" me for treatment; this step of approval was necesarry to even make the first appointment. Also, the recent physical in my MR's included a urine test for blood levels and kidney function (and the liver as well I think  ). Also, the MR's are incredibly detailed and include all the surgeries, the MRSA infection, recent MRI's and an appointment specifically for getting the referral to the PM specialist. It's just that the appointment is scheduled for 2 hours and I'm not really sure why they would need this much time if they weren't going to sort out my medication needs. There is a ton of paperwork regarding controlled substances, waivers and agreements and such, they seem very oriented around meds.
Thanks for all who respond, any feedback is greatly appreciated.
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#684820 - 04/17/08 02:58 AM
Re: What to expect at Pain Management first appointment?
[Re: LBJ]
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Lynx4
Veteran
Registered: 08/08/07
Posts: 588
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LBJ, all PM clinics are different but I can give you my experience.
I was referred there by my PCP, and got in a month later. I filled out a ton of paperwork and signed a contract about medicine. At my first visit we talked about what medicine I had taken before, what worked and didn't work, and that I would be required to do a pee test within 24 hours.
I left that day with prescriptions for 2 Schedule II medicines (one long lasting and one breakthrough medicine) plus Lyrica and a sleep medicine, which in my case was Ambien, since Lunesta was a horrible medicine for me.
I took my urine test within 24 hours, which should only have whatever medicines you told them you were taking when you filled out the paperwork. I was asked what I was currently taking on my paperwork and told them Percocets, hydrocodone, Ultram and Valium. So, those could show up in the test but nothing else. They didn't ask me where I got the medicine, although it was from my PCP.
I went back each month to get my prescriptions, talk about other things that might help (epidurals and such) and see if my medicine was working. They did change the medicine or up the dosage if needed, with no problems at all.
They prescribed narcotics for every person in that clinic. It was clean, well run, the doctors were associated with a University close by and everything was by-the-book. I was given several random drug tests, of which I always passed but I was never called to bring in my pills for a pill count. The only time they counted my pills was if my medicine wasn't working and I called before the month was up and wanted to change it. They would change it, but I had to bring the excess medicine I had back to them. They counted it I suppose, although I never saw where it went once the nurse took it, and they prescribed something else.
They were a good clinic and I appreciated all they did, but they were very big on the epidurals, burning the nerve endings and other procedures. In my case I simply couldn't tolerant the non stop procedures and felt they would kick me to the curb if I said No to even one of the tests or procedures they wanted to do. The procedures often caused me more pain for a week or two and they never gave extra medicine for it, so I would find myself low on medicine and rationing it out at the end of the month. It was very hard some months and since I seemed to have to have procedures every 3 months or so, it became hard to keep my pill count right and I would run low or run out before my next visit. It was crazy expensive and I thank goodness that we had insurance that covered everything but a $20 copay.
I would say if you filled out a Narcotics contract and you were asked what you were currently taking, you'll leave with some type of medicine today. They prescribed your first month of medicine based upon what you are currently taking and how well it works. Since I was taking 30mg of percocet a day, they started me on, what they considered, to be a higher dosage than they would have liked. The doctor winced when I said 30 mgs, because that seems to be a cut off point on where they start you at for medicines. If I was below the 30 mgs of oxycondone they would have used hydrocodone, but since I was at the 30 mg mark they never even considered hydrocodone. I was given Fetanyl patches, percocets for breakthrough, then Mscontin, then a higher Fetanyl patch, then Opana ER.
Good Luck. Just answer the questions they ask truthfully, make sure you list any medicines that may be in your system or you'll be kicked out next month, don't ever drink alcohol while on the medicines because you don't know when you'll have to do a urine test and make sure you are always clean and well groomed.
One thing I can tell you. Never, EVER call them and say you ran out early and need more. For one, they won't give you more, they will give you a cocktail of medicines to prevent withdrawal until your next visit, but it will be in your records, and they will be very cautious with you after that. That's why I dealt with it myself and never called and said I was out of medicine early. You can switch medicines in the middle of the month, but you can't admit to running out.
You are allowed to go to the emergency room and get medicine with no problem, but they usually require that you call them. They even asked monthly how many trips to the ER you had to make that month. So don't be afraid to go to the ER, just let the ER doctors know you are in PM, and call your PM doctor ASAP afterwards.
Again, good luck and please let us know how it goes.
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#684837 - 04/17/08 06:06 AM
Re: What to expect at Pain Management first appointment?
[Re: Lynx4]
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LBJ
Pooh-Bah
Registered: 11/28/04
Posts: 1245
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Lynx4,
Thank you soooooo much for responding to my post! This is exactly the kind of information I was looking for. I just woke up from anxiety & pain and I'm on Pacific Standard Time!!!... 5:30AM...  ugh! One of the reasons that I am a little bit nervous is because I have been self medicating and not all of my meds come from my PCP and they are fairly powerful Schedule II's (OC-80 2x day, MST-IR TID for b/t pain and 0.5mg of Clon TID for sleep) and I'm basically only going to the clinic to get (hopefully) the same dosages in a perfectly legal, medically safe and insurance-paid environment. I think this is a fair request.
Anyway, I've been second guessing myself if I should tell them everything that I'm on, but now it is very clear to me that after hearing my girl friend's advice and after reading your post that I must be completely honest with them. My GF is actually a pharmacist and no, there's not a single perk (or perc, lol) that one might think you'd get (apart from good lovin' ) as she is very strict. But she knows the levels of pain medication that I take; she is very emphatic that I tell them exactly what I'm on for medical integrity, of course, but also so they correctly prescribe according to my dosages. Also, the clinic was very clear over the phone that they "don't judge" their patinets; I use quotation marks because that is what the nurse said over the phone literally 3 times. So I'm going for it, I'm going to be honest and let the chips fall where they may. This drug-war climate has me feeling like a criminal when all I am is a person in pain who needs proper treatment.
Thank you again for responding Lynx4! Once again, DB and its members pull through with the great advice! 
I will report back later today with the results.
Wish me luck!!!
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#684922 - 04/17/08 10:00 AM
Re: What to expect at Pain Management first appointment?
[Re: LBJ]
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stillhopeful
Journeyman
Registered: 04/01/08
Posts: 90
Loc: usa
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Lnyx4,
I second everything LBJ wrote...our experieinces line up almost to a T! Execpt that my PM doc did require all meds to be brough tin each visit for counts...Once I was low, missing about 12 pills ,b/c the appointment was actually 1 day early adn I was only off 1 days' count, I just told him I had takena few extra the last few days and he was okay with that....had it been a very early appt.or mid month one, that would not have been good to be out...In my clinics' case, they preferred that I did not go to ER or Urgent Care (which is why I ultimately was released)...once is okay, but anymore than that they would start to worry....in any case, I learned, in hindsight, to always always call and tell them any meds another doc has prescribed...it will go in your record, you may get a lecture, but at least you should not get kicked out for violating PM contract...however, if you regularly go to ER, Urgent CAre, PCP, whatever when you run out of meds, you will most likely get kicked out even if you tell them as most PM contracts contain a section where you agree to not seek narcotics for the same medical condition the PM is treating you for......in short, avoid getting more meds from any dr. or pharmacy....
As far as telling htem what you are taking, so true....they are not worried about the amounts, or legitimacy of what you have in your system when you come in for 1st visit...only that what you tell them is what shows up on screen....after 1st visit, be aware that they can test the specific levels of meds in your system, at any point (in my clincs' case, monthly)...they do this to ensure that you are taking what they give youa nd not selling it, and that you are not getting extra from elsewhere....just a precaution....
ALso, most contracts allow them to run your name through your states PMP as needed....so, if you are going to other docs, beware, they will catch you is they look into this...and from what I understand, my clinic did this randomly and when they suspected a problem....
My pm doc was great, my only regret is that I did go to Urgent Care (told once, did not tell another time)....I really really wish I would have just told him and dealt with lecture or whatever, rather than not telling and getting kicked out - I really, in fact, should have just called mid month the first time and told him I was having to double up and that 4 doses a day were not lasting me, and needed 5 or 6....then he would have switched meds and I would have been okay,,at time, I thought I'd get in trouble, but now I know that a lecture is far better than a dismissal....if a lecture would have even occured - who knows...at least I would have been "safe".
Another thing to consider is the PM docs recommendations for meds...my doc knew that what I was on was not taking care of pain and had tried twice to move me up to a stronger med (morphine), which I declined due to family and such thinking this med was too strong....you know, my mom and husband would have gone through the roof had I come home with a bottle of morphine! NOw, in hindsight, I realize that moving up would not have impaired me, just handled the pain better and more effectively...my doc saw it coming, I just could not....
Hope this helps a bit, along with what LBJ has stated....be honest, don't hide anything and above all, advocate for your pain when needed...your pm can be your best friend, so to speak, if you allow him....
hope your appointment goes well!
_________________________
still hopeful....
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#684957 - 04/17/08 11:07 AM
Re: What to expect at Pain Management first appointment?
[Re: stillhopeful]
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Kaiboshman
Old Hand
Registered: 03/12/08
Posts: 417
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Sorry I couldn't get back to your post earlier, LBJ, but I wish you good luck this morning. It would be great to hear how it all went for you.
These experiences were very interesting for me to read, as I had a MUCH different adventure with my PM clinic. I have been going there for a year and a half, and to date have never had to sign an opiate agreement (perhaps because I'm not on any sch. II's?). No urine testing has ever been required of me, or even been discussed. The paperwork I had to sign was only a couple of pages, and did not include many restrictions for me to adhere to, aside from being honest with my doctors.
Typically, when I go in, I have to shade in an area on a diagram of the human body, and rate my pain on a 1-10 scale. The doctor sees me for an average of 3-5 minutes, to make sure I'm not abusing my 20 vicodin a month (sigh). I haven't begun self-medication as of yet, but if the doc doesn't agree to either switch or increase my doses this following month, I will have to seek other avenues.
Anywho, when I first went in, I acted naive about all forms of medication...I know...It's best to be honest. But I've learned from years of experience that the more you demonstrate you know about meds and medical conditions, the more likely the doctor will be suspicious of your need (in general). It took 6 months of trying almost every medicine he had in his arsenal (excepting opiates), before he finally let me try hydrocodone. Oh well.
In short, I'm surprised that all of your clinics are so rigorous in their admission, or maybe that mine is so light on me, since it seems to be the anomaly here...or maybe, like so many others before them, I'm just not being taken very seriously.
Best of luck LBJ, I'm sure we'd love to here how it went for you! 
_________________________
"Most people's so-called reasoning consists of finding reasons to go on thinking exactly as they already do." - Colin Wilson
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#684981 - 04/17/08 12:01 PM
Re: What to expect at Pain Management first appointment?
[Re: LBJ]
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LBJ
Pooh-Bah
Registered: 11/28/04
Posts: 1245
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Well you guys, I had excellent results at my PM appointment! Thank you all who responded, your advice was very helpful!
First and foremost, I have to say that after dealing with my painful condition for almost 8 years, this doctor took the most interest in my condition and spent the most time with me in one appointment than any other doctor in my life! It was very refreshing and reaffirming, for the first time ever I didn't feel like I was convincing someone who wasn't even interested in the severity of my condition. He had also obviously read over my records thoroughly and every time I would answer a question or refer to something in my medical history he would quickly thumb through my records and locate the page that pertained to it, clearly showing that he knew my records and situation quite well! That alone was worth the price of admission.
My absolute favorite thing about how it went was that medication was such a small aspect of the evaluation and treatment. He really focussed on getting me a new orthopedist and physical therapist that were focussed on not only recovery, but recovery using pain-sensitive techniques. He also made sure that they were close to my house. He went into great detail about what the future held and what I might have to look forward to; he did not give me false hopes and did not by any means guarantee any peramanent recovery as there really isn't one for me at this point, but he put such a great effort into helping me adjust my life to help cope with the pain in every possible way you could imagine. I was blown away by his level of interest and compassion.
In regard to meds, I am very happy that I was honest with him and that is the best advice that I was given throughout this process. It is the singlemost important peice of advice that I could pass onto anyone else considering pain management: Be as honest as possible in regard to your medication. I told him that I was on 80mg of OC twice a day plus 30mg of MST as needed for breakthough pain, but that I preferred the Duragesic patch for chronic pain and Roxi's for b/t pain. He asked me why I didn't just have my doctor prescribe as such and I just told him the truth: that when I lost my insurance I took it upon myself to manage my own pain medication and that I was getting all of my meds online. He gave me a funny look, and I told him, "Hey man, that's why I'm here. I'm making the best effort I can to manage my pain under your professional supervision as safe and as legal as possible. I'm trying to do the right thing"
At that point he practically let me write my own prescription as it was clear that I knew what worked best for me, there was no point in trying a bunch of different pain meds as long as I wasn't asking for anything outragous. He did mention that he didn't prescribe OC's due to their "street value" but I cut him off and said that I didn't want them anyway (which is true), for chronic pain even the Oxycontin are way too short acting IMO. Oxy is a great breakthough med, but not my first choice for the chronic med, and the contins are kind of crappy IMO, I never understood the hype. I'd much rather have a couple roxi's any day.
So I'm going to be on #15 100mcg Duragesic patches per month for chronic pain and #60 30mg Oxycodone IR for breakthrough pain. The only medications that he really wanted to be in control of were the nueropathic medicines that he wanted me to try, so I'm going to also be on Nuerontin (sp?) 300mg at night with incremental increases of quantity and frequency. If that doesn't produce results he then wants to try Lyrica. He actually wanted to go straight to Lyrica, but he said that most insurances won't cover Lyrica unless you start off with Nuerontin first. He said if I don't like it in any way I can stop taking it immediately, but I trust him and am willing to give it a try.
I cannot tell you guys how happy i am right now! Not just for the meds, but for just having a doctor who's sole purpose is to help my pain. I finally feel some comfort just knowing that I have a doc on my side. I am also very happy with the meds, hydro hasn't worked for me for a long time now and codeine certainly doesn't either. I will easily be able to stick to the contract, but the doc didn't seem worried about it and he didn't drug test me either.
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#684996 - 04/17/08 12:38 PM
Re: What to expect at Pain Management first appointment?
[Re: LBJ]
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LBJ
Pooh-Bah
Registered: 11/28/04
Posts: 1245
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Well you guys, I had excellent results at my PM appointment! Thank you all who responded, your advice was very helpful! First and foremost, I have to say that after dealing with my painful condition for almost 8 years, this doctor took the most interest in my condition and spent the most time with me in one appointment than any other doctor in my life! It was very refreshing and reaffirming, for the first time ever I didn't feel like I was convincing someone who wasn't even interested in the severity of my condition. He had also obviously read over my records thoroughly and every time I would answer a question or refer to something in my medical history he would quickly thumb through my records and locate the page that pertained to it, clearly showing that he knew my records and situation quite well! That alone was worth the price of admission.
My absolute favorite thing about how it went was that medication was such a small aspect of the evaluation and treatment. He really focussed on getting me a new orthopedist and physical therapist that were focussed on not only recovery, but recovery using pain-sensitive techniques. He also made sure that they were close to my house. He went into great detail about what the future held and what I might have to look forward to; he did not give me false hopes and did not by any means guarantee any peramanent recovery as there really isn't one for me at this point, but he put such a great effort into helping me adjust my life to help cope with the pain in every possible way you could imagine. I was blown away by his level of interest and compassion.
In regard to meds, I am very happy that I was honest with him and that is the best advice that I was given throughout this process. It is the singlemost important peice of advice that I could pass onto anyone else considering pain management: Be as honest as possible in regard to your medication. I told him that I was on 80mg of OC twice a day plus 30mg of MST as needed for breakthough pain, but that I preferred the Duragesic patch for chronic pain and Roxi's for b/t pain. He asked me why I didn't just have my doctor prescribe as such and I just told him the truth: that when I lost my insurance I took it upon myself to manage my own pain medication and that I was getting all of my meds online. He gave me a funny look, and I told him, "Hey man, that's why I'm here. I'm making the best effort I can to manage my pain under your professional supervision as safe and as legal as possible. I'm trying to do the right thing"
At that point he practically let me write my own prescription as it was clear that I knew what worked best for me, there was no point in trying a bunch of different pain meds as long as I wasn't asking for anything outragous. He did mention that he didn't prescribe OC's due to their "street value" but I cut him off and said that I didn't want them anyway (which is true), for chronic pain even the Oxycontin are way too short acting IMO. Oxy is a great breakthough med, but not my first choice for the chronic med, and the contins are kind of crappy IMO, I never understood the hype. I'd much rather have a couple roxi's any day.
So I'm going to be on #15 100mcg Duragesic patches per month for chronic pain and #60 30mg Oxycodone IR for breakthrough pain. The only medications that he really wanted to be in control of were the nueropathic medicines that he wanted me to try, so I'm going to also be on Nuerontin (sp?) 300mg at night with incremental increases of quantity and frequency. If that doesn't produce results he then wants to try Lyrica. He actually wanted to go straight to Lyrica, but he said that most insurances won't cover Lyrica unless you start off with Nuerontin first. He said if I don't like it in any way I can stop taking it immediately, but I trust him and am willing to give it a try.
I cannot tell you guys how happy i am right now! Not just for the meds, but for just having a doctor who's sole purpose is to help my pain. I finally feel some comfort just knowing that I have a doc on my side. I am also very happy with the meds, hydro hasn't worked for me for a long time now and codeine certainly doesn't either. I will easily be able to stick to the contract, but the doc didn't seem worried about it and he didn't drug test me either.
I just got back from the pharm, my total co-pay for all of that was only $140!
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#685053 - 04/17/08 03:03 PM
Re: What to expect at Pain Management first appointment?
[Re: stillhopeful]
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LBJ
Pooh-Bah
Registered: 11/28/04
Posts: 1245
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It's alright stillhopeful, it's easy to get mixed up on these forums in regard to whom you are replying to.
I appreciate your advice and input, however I found your story to be sad and ironically tragic. It seems like if you declined an opportunity to increase the strength of your pain medication you should've earned a "get out of jail free" card for the urgent care scenario. I'm really sorry to hear that you were dismissed against your will, that really sucks.
My contract says very clearly that I cannot go to the EC or ER as well without permission, and if I do go I certainly cannot accept any narcotic medication.
It is somewhat disconcerting that they would have you come in randomly and be obligated to do a "med count". I read my contract pretty closely and I don't recall seeing anything about this in the fine print; however, I'm sure that he could do whatever he wants and it would of course be a red flag if I refused. I wouldn't have a problem keeping the count "good", but it's like the national wire-tapping debate, "As long as you're not committing any crimes you don't have anything to worry about." Well, yeah, of course, but it's like I mentioned in the original post, I'm just not used to having my life scrutinized and watched so closely.
I also don't think it's very fair. I might have days where my pain isn't so bad, but should I be forced to take an unneeded narcotic? I'd rather save them for days when the pain is really bad and have the opportunity to double up on those days. But I understand the rationale and logic behind the drug testing and pill counts, I just don't like to have my actions scrutinized so closely.
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#685143 - 04/17/08 08:14 PM
Re: What to expect at Pain Management first appointment?
[Re: LBJ]
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Kaiboshman
Old Hand
Registered: 03/12/08
Posts: 417
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Hey LBJ, so glad that things worked out well for you! It sounds like you're finally on the path to receiving the health care you deserve, without the difficulties involved with self-medication. I can hardly imagine the sort of agony you must've suffered over the last eight years, and it sounds like you've been given a much needed break from the storm.
I have a PM appointment in three weeks, and was wondering what you guys think is the best way for me to diplomatically advocate for an increase in medicine. I would like to try switching to vicoprofen, since ibuprofen seems to help w/ my pain more than traditional vicodin. I'm just not sure how to best approach the doc with this proposition...
At 26 years old, and (luckily) in otherwise good health, my CP issues have been treated with extreme skepticism for many years. I had a botched testicular surgery at the age of 20 that's left me with permanent damage and acute pain. My doctors have all of the relevant medical records, including my ultrasounds which clearly show extensive scarring (as well as two large cysts that developed as a result). I just don't know what to say, anymore. I'm always treated quite unjustly. I think my PM clinic is the only one in the state (NE), so it's this or nothing. Any advice would be great, as usual.
Now I've gone and narcissistically turned this post in on myself. Sorry LBJ, I'm really not trying to hijack this thread. A sincere congrats to you for your success! Each one of us who gets adequate help is another ray of hope for the rest of us!
BTW, my wife and I just found out that we're pregnant a couple of days ago, almost 9 weeks! It's made me realize that I need to figure out this pain stuff before long, because there will be no room for impatience and grumpiness...it's my wife's turn for that...and I need to be her everything during the next couple years!!
Godspeed,
Kaibosh
Edited by Kaiboshman (04/17/08 08:22 PM)
Edit Reason: Baby Talk
_________________________
"Most people's so-called reasoning consists of finding reasons to go on thinking exactly as they already do." - Colin Wilson
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#685149 - 04/17/08 08:36 PM
Re: What to expect at Pain Management first appointment?
[Re: LBJ]
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stillhopeful
Journeyman
Registered: 04/01/08
Posts: 90
Loc: usa
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so true about having your life scrutinized...however, I'd give my right arm to have a pm doc that was willing to scrutinize me!!! if it meant getting adequate treatment, i'd do anything required....you don't know a good thing until it's gone....
as far as not taking meds on days you don't need them and saving htem up for days when oyu do, well...your PM doc may not care are much as mine did....I think typically, as long as you don't run out early, call in for w/d meds, and pass your urines and pill counts at monthly appts, you should be good...I knw the costs to test specific levels of meds in system are very expensive and not usually done every month...believe, you'll get the bill when they do one b/c most ins. reject this cost....you might see how it goes for afew months then have better feel for your docs ways...maybe even ask him about the Rules on that...some docs just want you sticking to your monthly amoutn, regardless of how you take them, as long as you take them all at some point...(obviously not taking them all in 3 days or such)....I can you that my uncle still goes to my old pm doc and he regularly breeze thru his meds in record time (w/in a few days - awhole month's worth) and his screens have always been okay, but he never calls in for early meds or goes to ER or such...he feels that as long as they have no reason to suspect misuse (or underuse) they will not question it...and, given his history, it seems to be true......I am not advocating such behavior, only pointing out that the more red flags they see the more likely they are to screen for specific levels of meds....
good luck on this journey, as it is a long and winding road, trying to keep tolerance in check, meds working good, and not ending up on high doses of meds....chronic pain is not something I would wish on anyone.....ever....for me, being young (under 40, over 30) getting on morphine now left me wondering "Where does that leave me in 10-15 years?" the prognosis was not good in any scenario....even my PM doc told me that my future was one of hard choices.....if morphine is the answer when I'm this age, aht in the world will I have to take when I am 50? I guess, in some ways, my current "break from oxy is good in the long run....maybe this is the way, breaks from mesd every few years to give my body a rest and clean it up....and hopefully, keep my tolerance in check somewhat....only, realistically, the pain is too much to allow me to keep functioning during these "breaks"....nice theory anyway!!!
hang in there, keep positive, kepp honest, and keep hoping...you never know what tomorrow will bring!
_________________________
still hopeful....
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#685152 - 04/17/08 08:48 PM
Re: What to expect at Pain Management first appointment?
[Re: Kaiboshman]
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stillhopeful
Journeyman
Registered: 04/01/08
Posts: 90
Loc: usa
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kaiboshman,
I think this "wave" icon is needed for you! congradulations on the baby!!!! my siser had her first last September and I can tell you that there is nothing in world better for chronic pain than the joy anew baby brings! even on my worst days, I will grin and bear it when my nephew is around....his smile makes everything melt away for the moment.....many great days in store for you and your wife....
I would just honestly tell your doc that you are supplementing w/ Ibuprofen already and want to switch to Vicoprofen (tell him a freind told you about it or you read about it or ask him if there is some hydr-combo w/out APAP and IBU instead- if youwant to play "innocent")...either way, pick an approach, tell him the APAP is not useful for you and the IBU works better....if the hydro is not cutting it now, tell him...learn from me...advocate for our pain! 20 hydros a month is nothing....not even 1 a day.....if you have been on hydro for any length of time, you have developed a tolerance and probably need 2...a few times a day...aks him how you are supposed to maintain activity of less than 1 per day.....follow his lead, you will know if he is receptive.....ask for input, recommendations (they like to fell needed and relied on -- like the patient knows nothing...)and honestly, a good doc should have some insight that the typical patient does not have(though the majority somehow miss this mark, IMO)....You have not seemed liek one who calls in early for meds, double dips, and goes to the ER every week....if those behaviors were present, your doc might have reason to worry...but, since that does not appear to be the case, he should have every reason to beleive you and take you seriously....good luck!
_________________________
still hopeful....
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#686076 - 04/20/08 05:09 PM
Re: What to expect at Pain Management first appointment?
[Re: crest]
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LBJ
Pooh-Bah
Registered: 11/28/04
Posts: 1245
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LBJ, If you don't mind me asking, were you referred to this clinic or did you find it on your own? I have been thinking about the pain clinic route but would be afraid to ask my PCP for a referral. I know many PM clinics require a referral.
I actually found him on my own doing research on the web (a combination of directories and pain management info sites & forums). I called them directly and asked if he was taking new patients (sometimes they don't take on new patients as they have a limit to how many prescriptions they can write). They said that they would take me on if my records were good and warranted pain management. So I brought in my records and got a call becak the next week saying that the doc approved my records and all that they needed was a referral from my PCP or another recently seen physician. I actually didn't have a PCP since I lost my insurance but once I got my insurance back a couple months ago I went on the hunt for a new PCP. I found one but he was a real jerk; if you look at my post on the Cymbalta thread you'll see why. He said that nobody will ever operate on me again due to the risk of my MRSA infection coming out of its dormant state. He said that I will be in pain for the rest of my life and that I should take Cymbalta to help with the depressing fact that my life was now worthless. I was so depressed by his prognosis and decided not to give up. I went on the hunt for a PM doc and you guys know the rest.
For the referral, I got the fax number of the PM clinic and simply caled the jerk PCP's office, gave them the fax number and told them that I've decided to see a "specialist" for my condition needed the doc to fax over a prescritpion for treatment right away. The nurse 9or whoever I was on the phone with) checked my file to see what my problem was. She said, "You were in here for knee pain?" I confirmed this. She then asked, "So you're going to go see Dr. 'so-and-so' (so-and-so is not my PM doc, he must have been their PM doc of choice)?" I said "no" that my PM doctor was [...]. I was very matter of fact, not rude, but i certainly wasn't asking them for any favors either. i was telling them that they needed to fax over the scrip. I kept it brief, but I was prepared to tell them that they never helped me one bit for what they charged me and even caused me a great deal of depression and anxiety with the doc's bedside manner and dismal diagnosis.
But I didn't have to. She just said that she would call me back. 30 minutes later she called me back and let me know that the doctor had faxed over the scrip and that I could make an appointmnet directly with the PM doc. I never plan on going back there again, he was a jerk and a bad doctor anyway. I'm very happy with my new PM doc and if I need the services of a PCP I'll get a referral from the PM doc, lol!
I hope this helps, crest, and I wish you the best of luck with your search.
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#686116 - 04/20/08 07:23 PM
Re: What to expect at Pain Management first appointment?
[Re: LBJ]
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MelMac
Newbie
Registered: 04/11/08
Posts: 45
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If you have a legitimate, documented or documentable problem requiring pain management, go see a Pain Management specialist.
It seems that PM doctors are built up to be this untouchable, "no way they will see me", type physician.
If you aren't happy and want to be referred to a PM doctor, do exactly what the above poster did. Call your PCP and tell them calmly and matter-of-factly that you want a referral to a PM doctor. Don't ask them, tell them.
So many doctors, and their first line of defense, their phone answering nurses or techs, are used to being ASKED for things.
If you ask if you should see a PM, they will probably suggest you come in and speak to your PCP again.
Pain Management doctors are receptive and helpful and more than agreeable about getting you the proper pain relief that you need.
They see tons of patients a day so they can usually smell a rat or an addict in a second, sometimes not, but usually.
If they believe you and your records support you, your pain management becomes a team effort between you and your doctor.
One poster said that he didn't have to sign anything at his "pain management" doctor and he still gets his 20 vicodins a month. No offense, but that doesn't sound like a pain management doctor.
If 20 vicodins a month work for you that is great but you could probably get twice that many from a regular GP without any hassle.
All PM clinics require extensive examination of any new patient and an ironclad, signed agreement that states that they will trust you and give you as much medication as you need to be comfortable and live your life.
In return they expect you to be responsible. The list of things they require of patients are all common sense things.
Don't sell, give away, lose, or take too much medication
Don't call and say you lost meds or they were stolen.
These behaviors will get you booted. No questions asked.
MM
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#686135 - 04/20/08 08:11 PM
Re: What to expect at Pain Management first appointment?
[Re: MelMac]
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Kaiboshman
Old Hand
Registered: 03/12/08
Posts: 417
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Pain Management doctors are receptive and helpful and more than agreeable about getting you the proper pain relief that you need.
One poster said that he didn't have to sign anything at his "pain management" doctor and he still gets his 20 vicodins a month. No offense, but that doesn't sound like a pain management doctor.
If 20 vicodins a month work for you that is great but you could probably get twice that many from a regular GP without any hassle.
All PM clinics require extensive examination of any new patient and an ironclad, signed agreement that states that they will trust you and give you as much medication as you need to be comfortable and live your life.
In return they expect you to be responsible. The list of things they require of patients are all common sense things.
Pain Management doctors are not all created equal. This makes it sound like you can just walk into a PM clinic and ask for whatever you feel you need, and walk out with no worries. I didn't have to sign an opiate agreement at my pain management clinic, but I did have to sign papers attesting to my honesty throughout the process. I certainly never saw any literature stating that they trust me and are willing to give me as much medicine as I need to be comfortable and live my life...
I searched for six years for a compassionate doctor before finally being referred to an actual pain management clinic, and a miserly 20 vicodin is all I'm given...since you seem to be such a guru, melmac, maybe you can tell me what magic utterances I should direct at my PM doc to give me actual pain relief.
Personally, I believe the medical community is rife with ageism, and if I were a 55 year old (instead of 26) with extensive testicular damage resulting in a grave suspension of any sort of "normal" activities, they would throw whatever meds I needed at me. As far as getting a GP to prescribe me more than 40 vicodin a month...I can't even fathom something like that occuring...but then again I don't have the money to doctor-shop and find out.
Edited by Kaiboshman (04/20/08 08:12 PM)
Edit Reason: edit
_________________________
"Most people's so-called reasoning consists of finding reasons to go on thinking exactly as they already do." - Colin Wilson
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#686158 - 04/20/08 10:10 PM
Re: What to expect at Pain Management first appointment?
[Re: LBJ]
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Kaiboshman
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