How to tell doctor current treatment in inadequte?

I'm having trouble getting through to my doctor that my current treatment is inadequate. I'm currently taking a low dose of Vicodin, a prescription NSAID, a low dose of a muscle relaxant, Cymbalta, and several recommended supplements. I've had the injection that was recommended, with no benefit. I've been doing PT for months, which is improving my flexiblity and strength, but hasn't brought down my pain level. How do I get through to my doctor that what's been tried so far isn't helping enough? I'm still in pain to the point of being in tears far too frequently. I still manage to drag myself to work -- most of the time. Housework rarely gets done. I'm currently paying for helping my daughter clean her room this weekend, which she needed my help to get back to a reasonable level so she can keep it up from there. I'm also extremely limited in what I can do otherwise because it will just send my pain level skyrocketing. I can't be on my feet for long at all. If I ride in the car too long, that also increases my pain. The school year starts for my dauther next week, and I can't even handle the walk from the subway station to her school since it's uphill. I'm very frustrated, and don't know how to communicate this to my doctor in a productive manner. I've been seeing both my primary care doctor and a spine specialist for these problems, both of whom are part of the same health care system. One does the injections and prescribes some of my meds. The other prescribes the rest of my meds. They both have realtime access to my records from one another are are in contact with each other. Howver, it also means I never know who to approach first with these types of questions. Any advice you may have about this mess would be greatly appreciated.

Pain Management Doctors are to do just that, help manage your pain. When you're not with him he's to provide you medication to where you can manage it on your own so that's who I'd be speaking to about your problem. You can tell him exactly how you're feeling. Be totally honest and tell him it's just not working out currently. You're seeing a PM specialist, if you have insurance your provider is paying big bucks for coverage along with the medication. My PM Doc is fantastic and I'd be paying for lots of hospital visits without him.

If this were me I would tell this dr just what you said here that you have done your part of what has been asked with no improvement. Make it clear that nothing has changed and you must have some relief because of how the pain is affecting your ability to care for your daily needs. Make it clear that it is affecting you at work and just say I think its time you send me to a pain mgt dr.. I hope you get some help....

Susie

Thanks for the advice. I had already sent a message to my primary care doctor because there was a mix up regarding my most recent medication renewal. It was handled by someone else in her office while she was on vacation. Hopefully I will hear back soon and we can discuss this.

I'm not sure. I sent a message via the office's online system earlier today, but haven't heard back yet. That likely means she's back though, since if she's not in the office a member of her office staff usually responds as such on her behalf. Perhaps she's consulting with my other doctor before responding. I doubt I have any chance of hearing back today since it's so late. I'll follow up if I don't hear anything back tomorrow.

I signed up for a managing chronic pain exercise class my physical therapist recommended (she teaches it). Perhaps that will help. I'm willing to trying almost anything at this point. I can't keep living like this. Existing is perhaps a more appropriate word than living in this case.

I know there are stronger and perhaps other types of meds that can be tried. My young age (I'm in my 30s) seems to frighten doctors, but I've been dealing with chronic pain since my mid-teens. The thought of several more decades of pain is frightening and depressing.

If you are needing stronger pain meds there is a real good chance your primary care dr tells you he/she cannot rx them to you. The new law now requires all drs that treat pain mgt patients they must take extra classes for PM and get a license for it. Even though my PM dr treats nothing but pm patients she must take additional classes and every year get a new PM license. This is one reason PCP's have stopped treating PM patients.. The DEA goes around checking to make sure everyone has a current license....Susie

I'm hoping she's back from vacation. It was a colleague of hers that refilled my prescriptions last week. She allows whoever is covering for her vacation to order prescription renewals, and it was my regularly scheduled time for as renewal. What I was referring to above is that I was hoping to get a response back from my actual primary care physician so we can discuss everything that's going on.

I'm not in pain management yet. I've mentioned the possibility to my primary care physician a while back, but she insisted that she's fine with prescribing my meds. I've previously gone to the pain management clinic that's part of this medical center, but not since my last surgery.

Thanks Tina. Any physician that writes a rx for controlled dangerous substances has to be licensed through the state and the DEA, ie the drs ie DEA # But, there is nothing that distinguishes PM from other drs regarding the DEA or even states when it comes to rx writting.

If I misunderstood, I Apologize. It's been a long week. I'm gonna call it a nite.

In my state this is what has happened to drs taking care of pain mgt patients that rx's narcotics. My PM dr was talking with me about this Monday. The DEA paid her a visit this year to make sure she had renewed her license. The license cost nothing but it is required by the DEA. So, my post above was not a mistake.....Susie

This is not new and applies to all Physicians and is not new-

"Under the CSA, the term "practitioner"is defined as a physician, dentist, veterinarian, scientific investigator, pharmacy, hospital, or other person licensed, registered, or otherwise permitted, by the United States or the jurisdiction in which the practitioner practices or performs research, to distribute, dispense, conduct research with respect to, administer, or use in teaching or chemical analysis, a controlled substance in the course of professional practice or research. Every person or entity that handles controlled substances must be registered with DEA or be exempt by regulation from registration.

The DEA registration grants practitioners federal authority to handle controlled substances. However, the DEA registered practitioner may only engage in those activities that are authorized under state law for the jurisdiction in which the practice is located."

http://www.deadiversion.usdoj.gov/pubs/manuals/pract/section2.htm

M&G, we are talking about prescribing controlled substances like pain meds long term for chronic pain.

Not only is a PM more advanced in their training and knowledge, but as mentioned, there are new state laws in many places as well as DEA pressure to have many of those non-PM Drs. deciding to not prescribe those type of meds, (long term), or treat someone with chronic pain. That's all we are saying.....is it could be the reason her Primary and Spine Dr.. does not want to take on her treatment with stronger pain meds.

Hopefully damgalnuna will give us an update when they hear back from the Dr's office today!

Post Edited (Snowbunny21) : 8/28/2013 9:17:40 AM (GMT-6)

I would just tell her that you are still in tears very often and your pain is not controlled. Just like you told us.... I'm not sure if you keep a pain journal but you can show that to her as well and she can see any trends like the time of day you are in the most pain, the days you are bedridden and things like that.

Good luck to you tomorrow. I hope they manage your pain soon. Hopefully you'll even feel better for the holiday. :0)

My appointment went fairly well. I typed up a list of the symptoms I've been experiencing and gave it to my doctor because I tend to forget things when I go to medical appointments. We talked for quite a while. She increased my Vicodin a bit and suggested I take it three times per day no matter what because she says that I've been "chasing the pain." She also prescribed lidoderm patches for the SI joint pain. She also referred me to a psychologist because she felt I would benefit from someone to talk to about the chronic pain.