Will 1st PM apt be treated as a consultation, & are there PM dr who don't prescribe rx's?

I am so relieved that I got accepted with a great PM dr. He has great bedside manors, even the receptionist told me he really sits down and spends a lot of time with his patients. I use to have a friend that went there & she said he doesn't like NSAIDS too much because of the damage it does. In fact she got an ulcer from NSAIDS. She said he gave her a few different medications to test out to see which ones work best. He's the kind of guy who will give you BT meds as well as ER meds. Actually I think I answered my own question, on her first visit she walked out with fentnyl patches, dilautid tabs & oxycodone. But she is 51 & I am only 24 so it may be a different story for me.

Reason I ask this is because I have had a lot of apt where the 1st visit was only considered a "consultation" and they don't prescribe anything during "consultations". I think thats just a way to pull $ out of people. My husband had a consultation for his teeth, he had a bad infection, well still does, the dr wouldn't even give him antibiotics! Antibiotics, really?

My sister had an apt w/ PM he told her he doesn't prescribe RX's. What? A PM dr who doesn't prescribe Pain Management medication. That doesn't sound right. He said it was only a consultation for cortizone shots. I think it is because her primary dr probably put in the notes/report of the referral that she broke her contract. What do you guys think? Are there really PM dr's who wont prescribe pain management medication?

Vickie, I kind of have to disagree on that. I feel drs who wont prescribe someone who is in great amounts of pain something that relieve them of their pain wouldn't be a good dr because he is not treating the patient with what that patient needs. There is nothing they can do for my back. My primary did an x ray and saw how messed up it is, you should have seen it, it looked bad. Just a block of bone one bone. The t9 compression fracture is so bad that my dr said I pretty much have 2 options, & said well kind of only one. Your going to need surgery on this. He said you can try PT but he really doesn't think it's going to help much. It doesn't, I've tried with previous drs to be perfectly honest PT made my pain a whole lot worse. Injections, such as a cortisone shot wont help in this situation, isn't cortisone to try and help stregnthen the bone or build more bone, I'm not totally sure what it is but my vertebrae is fuzed together & that wasn't done in surgery, it fuzed together on its own. The compression fracture is putting so much pressure on my spine that it has created a curve, I want to say a kenosis. I have tried chiropractry and it helped for a couple minutes after it was cracked but then the pain just came right back. I've tried stretches and a lot of times I'll do a stretch & get stuck in that position so I'm afraid of doing stretches because when I get stuck it's like my spines locked up on me and I have to really force it to get back into a normal position & then I am left with agonizing pain.

He is not a bad dr, he's not just treating my friend with just pain meds, he is also having these other procedures done, I'm not sure what they're called or what they are. He is also requesting I get an MRI done. I'm not too sure why since I have the x ray. Plus like I mentioned in my thread, he spends a lot of time with his patients to figure out what's the best approach/way to treat you. A lot of dr's these days just rush you through your apt & don't even listen to your symptoms or concerns. In fact he spends a lot of time going over notes, & x rays and your medical records before your apt is even made, he wants to see & make sure he will be able to treat the problems the patient is having instead of letting anybody go there & be told he can't help you which I just recently had 2 dr's do this to me.

It seems you are in favor of "consultation" appointments. Why? Don't you feel like it's a waste of your money? To me I see it as the dr saying "hey why don't you come in for an appointment, I'll look at your x ray, notes, diagnosises of fibro, oh you have a compression fracture that must be really painful. I'm going to schedule you for another appointment to get your treatment & your going to have to wait another however long in pain before you can get some relief." How is that good for the patient? These consultations make no sense what so ever.

I don't mean to be so defensive but I don't think you understand my conditions of my back. You don't understand that no one has ever wanted to give me the medications that I need so I can actually get out of bed in the morning. I can't even sit for very long because my hip will start killing me on top of my back pain. My pain levels are so high that I cry so much. My frustration of all the drs just trying to waste my time and $ on things that I already knew wouldn't work. I have been being treated for back pain since I was around idk 9, 10 years old. Had chiropractic treatments for 5 years. As I have said in other threads my pain level on a scale of 1-10 is 30+ I just feel like your trying to say I'm not going to go by the guidelines, or that all I want is pain relieving medications. I have been open to othewr options and ideas for 14 years, that is a long time to have to suffer because no one wants to truly help me.

One thing a lot of people who don't truly understand what it means to be in massive amounts of pain, levels so high your forced to go to the er because you can't even move an inch. Who have been through treatment options after another (non medication treatments). There are some people who have no other options besides going to the pain meds, why do you think I've been sent to one finally. The dr realizes I've tried so many other things, again my dr said my options are basically surgery or I'm out of options. Please understand that I really do want to get relief, that I am open to options. I was supose to get this epidural type thing done and it would keep me pain free for like 3 months, I was totally into the idea, the thought of not having to have a clouded mind, of not having to be on so many different medications & so much of it, but at the same time I just don't see it working, not for that long. Another reason why I want something like a strong pain med is because I'm at the maximum dose on one of the meds I take, I'm on high dose of another med I take I feel if I got something that I know will actually work for me then I could take less pills, less mg's. I'm not lookin to get fent patches or dilaudtid, I'd like to start off on something lower probably oxycodone. Percocet use to help it but it doesn't anymore. I was given percocet, tramadol & nucynta at the er one time & it did nothing.

Jenni, trust me when I say I know how bad your pain is.  You probably have it more often than I have or did, but when your lower back goes into a muscle spasm you experience that "Locking up" feeling where you can't move and it takes everything you've got to just sit still and breath until the pain eases up.  I'm sure several other people here have been through the same.  I call that "locking up" spasm my level 10 and my normal pain throughout the day is probably around a 4-5 when I'm on my pain meds and muscle relaxers.  If I don't take them it would probably kick on up there to around a 7 or so, but a 10 is basically Immobile for me and I would go into tears when I experienced a back spasm.

That said, I have many family members that I would consider "addicted" to pain meds and muscle relaxers, one of which is my own sister.  She mopes around like a lump on a log all day and hardly ever does anything but sleep on the couch and watch TV.  She is 42 years old and lives with my parents because of her mentality and all the crap she has taken in her life due to her back pain.  So when I have my own sister like that, I understand where the PM doctors are coming from when they won't prescribe on the first visit.  If you keep good medical records and have that first appointment and they can see that you are really in pain, I would like to think they would try to schedule you to come back in within a day or two to get an injection, but I can understand their hesitance on writing a narcotic script right away.

When I first started having my spasms and major issues, I had already seen my family doctor, an orthopedic surgeon, done a couple weeks of PT (well tried to anyways), and none of that was working.  I went into the first apt with the PM doctor wearing two back braces and on crutches because I could barely stand up and move around.  He didn't write me a script the first day, instead he scheduled me to come in at 9am the next morning for the cortisone injection.  I do believe he wrote me a couple of scripts that day.  The very next day I was able to get up and drive to college to take my final exam which I had missed due to my back problems.  This was the last final to take before I could graduate with my bachelors, so you can imagine I was happy to finally be able to get up there and get that done.

It sucks that there are "pill heads" out there in the world that get addicted to the stuff and screw it up for the rest of us who are in real pain and take only what is prescribed to us to get by and have a better day than we would without any meds, probably just moping around the house or laying in bed all day.

Vickie, I just really want you to know that this dr is careing. He got 4 out of 4 star reviews, the comments left both were 4 star.


Currently 4 of 4 stars

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Sep 14th, 2011

He was running a little behind on my first visit, but my follow up was faster.He was very very friendly and cares for his patients.I've waited a long time for a Doctor in my area who had the education for cp patients, and knew about the medications for treatment.Thanks Dr XXXX and Staff!
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Currently 4 of 4 stars

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Aug 1st, 2011

Dr.XXXX is the most caring thoughtful doctor I have ever met. He genuinely cares about your condition and finding the proper treatment. He is also very open and warm to family members who accompany their loved ones to a visit or at the hospital. I have never had a better doctor.

Yeah, I get that. It's terrible with how things are these days. I called the PM & receptionistsaid IF he decideds he's going to give you something then you'll have it that day, he wont make me make a separate apt for it, thank God because I can't afford that. She said for injections I'll have to come back, he only does them on certain days.

Add to that I would be real careful calling and asking too many questions about obtaining narcotics at your first appointment before you even get there. Its a huge red flag and could very well cost you a Dr that will help you.

When I first went to my pain management doctor, my PCP continued to treat my pain and handle my meds until a contract would have been signed and I moved over to the PM's care. So when I first was scheduled to see the PM doctor my PCP was issueing my Oxycontin and BT meds. I had the luck of finding a great surgeon at the same time as I was not only focusing on one option. I only got my meds through my PCP but was seeing multiple doctors for a treatment plan. When my surgeon told me he thought he could alleviate my pain with a fusion I jumped on it. Now all my meds go through the surgeons office.

I moved my PM appointments back 6 months knowing that I will update my records if I need to go in and see them. The hope is by the time everything is healed I only need a very small amount of meds for really bad flare ups. My PCP has said at that point she would continue to prescribe so I do not have to see 50 doctors. In fact I went in 4 weeks ago to have an incision looked at and my liver enzymes checked, she asked if she needed to take over prescribing my pain meds. I told her right no the surgeon team is still comfortable handling it and said until a year post op they are fine manageminy my pain. At that point I go back to my PCP or to a PM doctor. Hopefully just my PCP for meds to manageme pain occasionally if not at all.

PM is a specialty med Dr,very likely one that you have to be referred to from another practice. The majority of people see more then one Dr and since PM deals with pain most are covered by a Primary Dr for all other things,like Sean some have a Surgeon onboard for a period of time as well.

PM Drs are not your first line of defense,you didnt become a chronic pain patient overnight and they are expecting someone to be covering your pain issues. Although not successfully or long term thus your reason for going to PM. Its this Dr that is your last line of defense. Its where we end up when our other Drs hit their limits of prescribing,failed to alleviate our pain,reached the stage where our pain crosses into the chronic category.

Saying that the PM Dr wouldnt be your salvation but your saviour. He is going to take over and maintain hopelly better you pain management. He is not expecting nor does he generally treat CPers with their first narcotics or pain meds,its highly likely and the norm that if your in that much pain for that long then someone of your other Drs are doing something for you. Him chosing to write or not write at a consult wouldnt be denying you relief or care but just leaving you under the care your already under for awhile longer.

I will tell you this though,I have seen some addicts so good at mimicking pain symptoms I would have not seen through it!! I had the Dr I worked for tell me that its really rather easy for them since without their drug of choice they are hurting. When I asked how he could ever tell the difference he said real CPers can and do walk away from a consult understanding the need to gather records and addicts will throw one big fit because they know once you get their records the ruse is over.

So yea,I get it.

To me, if your truly in so much pain you just can't bare then you'd be pretty upset having to wait another week to get relief especially when you barely got through the last week leading up to your appointment. I'm so confused as to how you "CPers" are ok with having to wait even longer to get relief. I'm not talking oh I hurt today no I'm talking "I'm in so much pain that it's taken ever will of my being to not go to the er bc that's how bad I hurt." I'm tallking so much pain that it's convincing you to get surgery done on your spine despite the high risk for being paralyzed. I am in no way an addict, I don't see how I could be, I'm on certain other medications like psychological ones that are known to block the so called "opiate high" look it up-welbutrin. So how would someone being upset about having to wait even longer for relief be considered that when they only get the pain relieving agent/benefit. I wish you guys understood me. :( Who knows maybe you guys don't see it that way bc maybe your not in as much pain as I am, or maybe you guys have a higher pain tollerance than I do.

Im not saying your not in pain at all!! Im saying that as a longtime CPer the majority of us dont rely on meds as the sole contributing factor to bring relief. We do so much more then that. So being told I have to wait for one methods not going to put me someplace I havent been before.

Any spinal surgery carries the risk of paralysis as do injections,nerve ablation,anytime invasive procecedures are being used in the spine thats the risk taken.

Jennie there have been times in this journey that if I was told consuming dog poo would work I would have headed to the dog park with a wagon and shovel!!

We have all been where your at some point or another. Just as the pain charts vary so does each of our pain and how we deal with it and describe it. How one person describes a 10 is totally different then how the next 20 does.

In actuality medical folks dont think your walking and talking at a 10,they take that a an over exaggeration. Yes everyone is different in how they interpret pain and how much they can tolerate but thats not to say they are in less pain then the next person. I know the longer you hurt the different you percieve pain.

That perceptions the key for most of us. I stop and ask myself if I can distract my mind for awhile if my perception of this pain will change? If it gets worse then I will do something different,if it gets better with distraction then I have brought myself time and relief.

If you allow the pain to occupy every corner of your mind,rule your every thought and moment then it becomes bigger then you,larger then your life and that dumps you in that dark place your talking about.

We use therapy,heat/ice,accupuncture,aquatherapy,physical therapy,massage therapy, mind therapy,crossword puzzles,reading,Xbox gaming,sewing,whatever we can in the hopes of finding some point of relief if its through hope that it works or merely a distraction. When all thats been tried and still fails occasionally yes we have to rely on strong meds to pull out but always always as a last resort not a first. That is the difference between acute pain versus chronic pain.