The time has come to join a pain management program - have questions and concerns

Hi Jayne, don't throw in the towel yet. At least give this PM dr a chance to see what he can possibly do for you. It may take 2-3 appts but at least give it a try. Your situation is different than what most of us deal with because of where your pain is at.

Since tomorrow is the first visit do not be surprised if he does not give you anything for pain. Most of them have the patient do a UA, depending on the results of the UA depends on whether he will prescribe pain meds on your return visit. More & more pain mgt drs are doing this with new patients. So, do not feel as though you are being singled out. Just go in with an open mind.

Make a list of all meds that you have taken & whether they helped or did not help. Be sure he has been furnished with any medical records from your previous drs that he/she has requested.

Be honest with him as to how the pain is affecting you. Be as descriptive as possible when describing the type of pain you have, that gives him a better idea what type of pain you are dealing with. Just saying I have pain is not really telling him anything, he knows you have pain otherwise you would not be there.

I would say I have been referred to you for help with my situation & I would like to know if you can help me or not.

I am not surprised that you have been referred to pain mgt. Our regular drs want no part of treating anyone with CP on a long term basis & I honestly cannot blame them. There is just too much red tape & PCP's just do not have the time to jump through the hoops plus they are equipped to deal with chronic pain like a specialist.

Good luck tomorrow & don't let it get you down. This dr may well be able to help. But, I will caution you, do not expect him/her to make you pain free. If it happens great, but expect to always have some pain.

I have trigeminal pain due to having both TMJs replaced. I also this had also created overall dental pain and nerve pain throughout the head. In some places it's like the surgery caused me to be rewired wrong. If I close my eyes and someone touches the chin, I feel it by my ear. Freaky:)
Trigeminal nerve blocks have helped me the most. I do take amytriptlyine-100 mg @night. It took a while to get pass the side-effects, and it only helps so much.

Who referred you for pain management? Can that Dr write a detailed summary of your symptoms so the pain doc understands? Is there someone you can take with you to validate your pain? I really hope you, and the new Dr, can come up with a plan. Don't be surprised if the Dr doesn't prescribe meds the first time. Sometimes Drs want their own tests run.

Good luck and tell us how it went.

None of us can tell you Jayne what to do, its your decision. For those of us that have years of pain mgt under our belts we can only give you the info from our own personal experiences. There is nothing worse than having pain & no one can tell you why the pain is there.

With the rules & guidelines that PM drs have to go by in order to keep their licenses to practice medicine it is a strict environment. Yes, there is a very good chance you will walk away tomorrow without a prescription for pain medication until a UA comes back. Yes, drs do have a tendency to get suspicious of patients that ask for pain medication. There are different types of injections that drs will do for different types of medical issues, whether this will be offered is up to the dr. As I posted above, explain what type of pain you are in & how its affecting you & ask for help. That is the best way I know to address your issues with a new dr, but its no guarantee you will walk out with a script in hand. Pain mgt is very expensive when paying out of pocket & you have no insurance for back up.

I think you may be making a big mistake by not seeing a good pain mgt dr to see if one can help you.

If the dr does the tox screens in his office, if you have a copy of your medical records that prove what the medical cause of your pain is and if there are no other issues, there is a chance that you will receive a rx. But, it may not be the same as what you've been taking. Drs have their own way of doing things and that goes for the meds they start new patients out on. But, you need to go back for at least one or two more visits. I understand the cost factor. I know someone now who is getting ready to be homeless because they can't pay for their pain management and also pay their rent. But, if you don't at least go back for a second visit, it will be a waste of money and you will never know what might have been.

Hi Jayne PM might just be the way to go! There are some very good caring and compassionate Pain Management Doctors out there! Granted they might be a bit rare now days but they are still around and you will never know if you can be helped by one unless you go and find out! I know it is difficult but try and keep positive about it!

When you meet the doctor just be honest about your situation and what treatment's you've had and how successful they were! What has worked and hasn't worked for you. Above all let him/her know how all of this affects your life! Ask him/her if he/she thinks they can help you. Be open to what to what they suggest ( show them you are willing to work with them to get your pain under control!) Then if it doesn't work let them know so together you can try something else! It might take a little time but hopefully they will be able to come up with something that will work and maybe even give you some long term relief! Right now it sounds like you really don't have anything to lose by at least giving it a try! I know it can be expensive but if you can get somerelief from your pain it really might be worth it! and you will never know unless you try it!

I do wish you well! Good Luck to You!

White Beard

Hi, I'm sorry to hear about all the issues you've been having.

Can I ask how long you stayed with the nerve meds? I know they can have some undesirable side effects at first, but those may go away, and it does take a while for them to build up in your system. You have to go up on dosing very slowly with gabapentin. What dose did they start you on? For example, I started at 900 mg a day about two months ago and am now up to 2800. I find it to be very effective. If I forget to take it, I can definitely tell a big difference in my pain.

It may not be the right med for you but I'm just saying maybe you could try it again and stick with it. Take it before bed and let your body get used to it, and increase the dose slowly. This is where PM docs are much better than GPs when it comes to treating pain, not just because they know the meds but they also know how to use them effectively.

I was also scared when I entered pain management, it felt like giving up or being put out to pasture, so to speak. But it has helped me tremendously. There are resources like referrals for hydrotherapy, counseling, injections, implants, etc.

Just don't give up. If you find a doctor who is willing to stick with you and find the right combination for you, that's priceless. Good luck and keep us posted on what happens.

Well, I made it back. I was SO nervous that I didn't even explain how debilitating this problem has become. The doctor prescribed me Lyrica which isn't even available at my pharmacy so I have to wait until Monday. He also gave me a prescription for Baclofen. I took one over an hour ago and it actually seemed to make my pain worse to the point where all I know to do now is just cry myself to sleep. The PM office is closed on weekends, not sure if that's a normal thing, but I have to wait until Monday anyway to try the other medication and see if that works. I don't know what I'm going to do if it doesn't. The doc told me due to regulations, I will not be able to get pain meds until the next visit which is in 2 weeks. I almost cried right then when he said that although I should be used to it by now since other doctors have sent me home in the same way without relief. I was just hoping since this is a PAIN clinic, my PAIN would be controlled but no, it just made matters worse. If he was going to prescribe the other 2, why not the pain med in case they don't work??? I am so mad and hurting SO bad but like I said, should've expected it.

Don't give up.

If you have nerve pain, Lyrica will help, though you better check to see how much it will cost. It takes a while to begin working.

Look at it this way, before you went you had no timeline or date where you might be able to get some quick relief. Now you only have two weeks. Surely you can make it that far. You've made it this far. Good luck.

When all else fails, usually 800 mg of motrin, then alternating ice and heat, can take the edge off of things for me. A *little* bit, but it helps at least being proactive about it.

Well it's been 6 days and I'm still in the same level of pain, if not more. The Baclofen is just not helping me plus I can't take it during the work day anyway since it knocks me out so even if it did help, I would still be suffering until bedtime. I have yet to receive pre-authorization on the Lyrica but once I do and can finally try it, there's no guarantee that it will even work so I called the pain clinic and told them I am not going to be able to get through another weekend with no relief so they scheduled me to come in tomorrow. Now my question is, do you think the doctor would prescribe me pain meds then??? I don't see why not but I was too scared to ask the nurse I spoke with so I just asked what the doctor would do differently this time. She didn't really have an answer, just said I would have to be re-evaluated.

I am new to PM been going for less than a year. I too did not get a prescription my first visit. I was on meds ran out by time my appt and I to had the same idea well it's PM they should be able to manage it. Well due to the new guideline they have to do the UA and to get that back. If they see u had previous pain meds in your urine test they will make u show proof that it was ur prescription. The dr told me this because I too was desperate for relief "I got into pain management to help people in chronic pain and if they would let me that is exactly what I would do today this minute however due to new guidelines the dea will not let me". So that being said he might be able to try a different med but it likely will not be a narcotic med. tell them about not being able to get the Lyrica. He might can try to push that along. But I promise it is not the drs fault at this moment. I will say you said you was taking prior meds from the oral surgeon. Likely, He's will want to see that bottle and will look at the date, how many, if it was within a year since prescribed bc if ur in such pain meds won't last a year. But whats important is this. Once you are prescribed pain meds take them exactly as prescribed, do not take pain meds from anywhere else (go to other dr to get pain meds) an extra one hear or there. If you run out early etc he can discharge u from his clinic and once discharged from a pain management clinic it's almost hard to find another one!

Another thing is this pain management drs are about the only drs that will prescribe pain meds long term so u are definitely going to need one if u are going to have to take them long term and that is getting stricter by the day. You also have to use the same pharmacy to get your meds. once you get your pain meds prescription you may have to wait 24 hours before the pharmacy will fill them the first time. I can't remember why one of the people above will know.

I'm 32 and my dr said it's the prime age for people to start trying to get meds to sell and thanks to these people they have made the ones who truly have chronic pain to get meds. These are the ones u have to blame. Give your dr a chance. I love my PM dr bc my goal even if far fetched is to not take them daily. He was my first PM doctor and will be my last. I told him he is not allowed to retire until I die. I was lucky once I got lined out I got a stimulator and done good till nov when I ruptured a disc. I'm having my 5th back surgery tomorrow. Just give him about 3 visits. I hurt so bad for a month with no meds. I couldn't even work was a horrible mom and wife. But they seen such a difference once I got the meds and then the stimulator was doing pretty good I was going down on meds. Until this now hopefully I can get healed and it will help. I hope u can get relief soon.

First of all, I am far from an addict. I don't even want to be in pain management and haven't felt right about it since joining. Before my teeth pain started, I had never taken a single thing for pain in 28 years while still dealing with horrible pain in other parts of my body. Teeth pain is far worse than any other pain and I've suffered through back problems, stomach ulcers, excruciating menstrual cramps, deep cuts, terrible leg muscle cramps, earaches, infected ingrown toenails, psoriasis, painful lumps on various places, etc. and never took a single thing for them but one thing about those pains is that they eventually resolved and went away. This toothache will NOT. I've been suffering constantly for TWO WHOLE YEARS and the only reason I'm now in pain management is because the pain spread from one area of my mouth to the ENTIRE row of teeth. A toothache on a single tooth is painful enough but try living in agony like this for ONE day much less 8 months straight. I bet none of you could do it. After going to NINE different physicians in 2 years and paying roughly $7000 out of pocket in procedures and trying to figure out why I'm in pain, I had no choice but to join pain management. Otherwise I would've gone insane (that chance is still on the table) but the fact that I'm now part of it and STILL in pain infuriates me. I don't care about regulations. I have a job too and that requires me to stay alert and focused for 9 hours a day and I certainly can't do either when I'm in pain or jacked up on nerve meds or muscle relaxers both of which knock you out for hours on end. I've had to quit a 2nd job because of this and can hardly manage at my current one. I can't earn a decent living like this. It's not my fault that this doctor is slow and is taking his precious time sending the pre-authorization form for the Lyrica. I've been on the phone with my pharmacy and insurance company ALL week and both said they are waiting for the DOCTOR to send it. So I called the doctor's office leaving multiple messages about it since Monday and only today did they call me back and when I was explaining everything to the nurse, she wasn't even listening and kept talking to her co-worker in the background. She asked if I could come in tomorrow and I said yes so I was trying to ask her what the doctor would do differently because I need to be taken seriously all while she was ignoring me proving that I am NOT in fact taken seriously. What the heck!!! But anyway, it took them THREE DAYS to return a call so how am I supposed to "try" the nerve meds if they can't do their job and send the authorization to my insurance company. If that doesn't get done, I would have to pay $300 out of pocket which I was told will NOT be reimbursed. As for past prescriptions, I have been prescribed other nerve and pain meds from my dentists and oral surgeon in the past few months after having a root canal and teeth pulled neither of which relieved the pain but those doctors are no longer able to keep prescribing them and that's understandable. The pain doc however has every capability and option to do so. I even printed off a list of EVERY drug that was ever prescribed to me directly from my pharmacy account and after the doctor looked at the list, he noticed hydrocodone was one of the last meds on there and specifically asked me about it to which I replied that it is the ONLY thing that has helped so far and gets me through the work day. He then explained that he would prescribe that for breakthrough pain (which I'm in now!) but the other 2 meds would be to see if the pain can be treated. The future appointment card also states "followup in 2 weeks or AS NEEDED" so that's exactly what I'm doing because I NEED RELIEF NOW. I can't get through another weekend like this. I managed to save one pain med from my oral surgery last month in case the pain got SO BAD and last night it did to the point I was having to massage my gums for hours just to get the tiniest bit of relief. I didn't take the last remaining pill though because I knew I'd probably need it more later so I just sucked it up and cried it out. There was no way I could get through another night like that so I ended up calling the pain clinic once again, this time at 1am because I was not able to get to sleep and told them what was going on with the current meds they have me on and said if they have to inject me with something then I'll take it. However, the fact that I have to hold on to a pain med "just in case of an emergency" is pitiful especially since this doctor could easily write a new prescription. What the does he expect me to do??? One thing for sure is that he is NOT in pain. I got more empathy from my ahole of a neurologist who rolled his eyes at me the entire time I was explaining my situation to him. Ugh.

Post Edited By Moderator (nvrthesame98) : 1/15/2015 1:59:39 AM (GMT-7)

I don't think anyone thinks you are an addict-far from it. Unfortunately we've all been on this chronic pain road for quite a while. I'm very blessed to have an awesome pain doc and an awesome medical team, but there are many members who have had some pretty brutal appointments. Everyone understands your frustration because they've lived it.

Trust me-I totally get and understand facial/head pain. With the replacements I had screws embedded along the top row and bottom row of teeth. I had to be cleared by a counselor to have the surgery because it is done purely for function, the pain is worse after the fact. Teeth/facial pain is a nasty beast because of the number of nerves. Grown men get tears in their eyes if they bite their tongue or the inside of their cheeks while eating. That's nothing…

Another therapy I've had is iontophoresis using lidocaine. It didn't work for me, but it was worth a try.

You will find lots of support here and he person has his/hers own pain story. We are a pretty strong group of individuals.