Upcoming visit to a pain clinic - what to expect?

Hi again guys

I have an upcoming appt to a pain clinic and I'm not sure exactly what is going to happen. I keep getting this romantic notion that the Drs I see set me on the right track with meds and pain reducing techniques and I live happily ever after with no pain.

Yeah right

I really dont know what to expect from this appointment. The thing that makes it more anxious for me is that I get the feeling my Rheumy set this up because he either

(a) doesn't know what else to do with me
(b) is unwilling to prescribe me stronger pain medication (even though some days I feel like I am being ripped in half) and would rather someone else do it

I'm Australian by the way, and would really appreciate a fellow Australians view on their pain clinic experience - did it help? at all? what can I expect?

The closer I get to the date the more anxious I seem to be getting

Cheers Guys

Thanks for the input Red. I also think my pain control is a bit complicated. None of the usual things have worked and I'm not expecting any miracles, though i would like to find a mix of meds that will work for me. I am on a mixture of narcotics which works pretty good to keep the pain at bay, but would like to find a good combination of non narcotic drugs to minimise the pain, though i have been on quite a few already and they don't seem to help much with the fusion pain and I have a feeling I'm not going to get through the worst of this without narcotics, which I hate being dependent on, and from past experiences with needles into the SIJ's I am now terrified of needles going anywhere near my spine, last time the pain was horrendous and did not abate for 2 weeks, 1 week of which i had absolutly no pain killers to control the pain. I simply couldn't move.

I had a CT guided cortisone injection into each SIJ..very very painful and that's what kicked off the bad pain - because the left one was so ratty he had to jab the needle in twice and my doc suspected they hit a nerve bundle, hence the excruciating pain. that settled after about 4 weeks and then the fusion kicked into overdrive, whether it was caused by the injections I don't know, but since then the fusing process has really sped up. both SIJ's and now the lower half f my spine is going to. Ive had AS for about 9 years now and Juvenile inflammatory arthritis before that, although I now suspect the JIA was really just the AS kicking off and I was mis-diagnosed. All I know is that since the injections, I cant function without 30mg morphine, 5 to 10 of oxy for breakthrough and Valium for when the muscles spasm and contract to try to protect the fusing joints. Even on that mix i still get significant pain, hence why im quite keen to find a good mix that will work.

All in all that's why I'm a bit hesitant about more needles in the spine area

On a side note though, i have recently upped my dose of enep from 25 to 50 and my usual wake up morning pain is all but gone, but still comes on later after ive been moving around a bit

no. Initially I was put on valium by my doc to help with what they thought (at the time) was muscle spasms, which actually turned out to be pain from the fusing process in the lower spine which at the time I was not aware of. as well as to calm me down a bit because the initial response and attitude I got from my rheumy was, in a word, crapfull and I was quite traumatised from it. I was then taken off them after they identified the fusing problem.

I recently requested to go back on them as one day I was in quite a bit of pain and my whole body was trembling from it. I didn't really notice as this was over a period of a few days. I realised when I topped up on oxy one day after having run out...after taking some and it kicked in, my whole body just relaxed as soon as the pain levels dropped and the relief pretty much knocked me out for a few hours as I hadn't slept in a few days, and never felt relief like that before. now when I experience lengthy flare ups, the muscles surrounding my SIJ's and lower spine contract and I tremble like anything, I cant help it I think at those times that the pain is more from the contractions and me being tense aggravating the problem as opposed to fusion pain. Id rather take valium to relax the muscles and drop the pain levels when I relax as opposed to taking the heavy stuff to manage it, as i would go through them to quicky and as we all know, pain killer management can become quite a juggling act when your on a few different types!

I have never heard of Skelaxin or flexaril - what are their advantages over valium?

Thanks for the tip, I will be sure to ask them. I was told MScontin is a great painkiller for nerve pain but my physio said I really should try to get on something that works well for 'bone pain'. All in all it works pretty good (atm I'm on 15mg twice a day) and drops the pain levels down a bit, at one stage I was on 60mg twice a day and it really didn't do much to stop the pain, and it was disconcerting being on such a massive dose of morphine that did not help so I dropped to 15, which has exactly the same effect painwise as 60; breakthrough & spasms are the real issue for me. while on 60 I was not allowed to have anything for breakthrough which was just as bad regardless of being on morphine or not. at least on 15 I can have oxy for the b/t if I need to or valium if the spasms kick in, but I'm pretty sure the docs only want me on Valium for the short term.

But on a good note, I think the Endep (amytriptaline?) is working well, I am no longer waking with pain, (last 2 days, fingers crosed!) it doesn't really start singing again for an hour or 2 of moving about. only 12 days to go till the pain clinic

oh and sorry I didn't answer your other question - I have Ankylosing spondilitis then was diagnosed with Sacroiilitis early last year (excuse the poor spelling) initially the cortisone was intended to reduce the pain in the SIJ's but something went wrong because since then the pain and fusion has kicked into overdrive and I'm not sure how the injections could have kicked it off?

Thanks Red

Post Edited (Shanno) : 8/13/2009 4:13:10 PM (GMT-6)

Hey Red

Yep, that sounds exactly like what is happening. Since I've got back on the valium the pain levels have dropped a bit, but more noticeable is I certainly don't feel as tensed up as I was, so am therefore in a better frame of mind and not as stressed when the fusing pain kicks in as it is easier for me to relax. also going for a massage tonight so tha should help to. 1 week to go to the pain clinic!