Pain Managment Dr questions and concerns

Hi there,

i had the misfortune of lifting weights that were too heavy, courtesy of of an incompetent trainer, almost 6 months ago, which caused disk problems in my neck and lower back. Since then, I have had a successful cervical medial facet branch block and will be undergoing a lumbar facet block next. I am scheduled to see a neurosurgeon about my neck about what to do next in that area.

One fallout from this incident is that I have great pain when I sit. Nerve pain. It makes it almost impossible to sit in less I am sitting on ice and so I can almost not sit at all. And of course with the facet problems standing is hard to and even lying down is difficult. All day long all i can use is ice below my waist right now.

My primary care provider has been treating me for many years. I currently take 5 mg vicodin 4 x day and 1/2 soma 4x/day. I also insert rectal suppositories of Valium which helped me with the nerve pain when I sit.

My RX for Vicodin is higher than this (The Rx is 10 4x a day), i just use less.- this is just my average for what I take per day - sometimes a little more - and so I have some left over for emergencies as I also get migraines from time to time, and sometimes the pain is a lot worse and I need more, but I try and take as little as possible because as everyone knows nerve pain isn't that easy to beat. I am also taking 100 mg Topamax for the migraines.

It gets exhausting not being able to sit, lie, stand, walk, etc. And have lower and upper disk problems.

So far I have had no trouble getting my RXes filled, perhaps because I have had lower back pain for years, even before the injury. Much of it had been fixed; the new injury exacerbated things dramatically by adding in the nerve pain. The neck problems are serious and new.

My physiatrist wants me to see a PM. Part of me wants to do it, of course, because I would like to get more pain relief than I am getting and also I am scared when I read others talk about how draconian the laws are getting. I have had a lot of bad side effects from other drugs that I have been put on that have caused me lots of bad problems in the past.

Not sure what my question is, but also, my PCP is getting on in years and is likely to retire soon. Also, will it look bad if I don't go to the pain manager? Can I give him a try and if I don't like it, I don't have to go? I know they believe in getting people off of opioids, but I honestly don't think I am taking that much in the grand scale of things. If I am not in pain, for example, I won't take any.

So maybe they are referring to people who are taking way more than I am. And, they seem to be doing some exciting new things and it's true, I could use the help. I am getting pretty depressed!

I really like my physiatrist and am willing to take new suggestions, I just don't want to be forced to do things that give me bad side effects. So I guess I'm just kind of scared. And I don't want to wind up with less than when I have now.

I'm sure so many of us realize we are not drug addicts. I would do anything not to have to take anything at all.

Hello, sorry to read about what you are dealing with in the pain dept.. I think your physiatrist is correct, you would probably get much better pain control if you were under the care of a pain mgt dr. After all, treating pain is their specialty. Most of us here at the forum are under the care of pain mgt drs. I prefer the single dr setting versus the clinic setting. I am not interested in the clinics where they have multiple different people that do this & that with patients.

Since you have this nerve pain why are you not on one of the medications used to treat nerve pain? There are several out there, its a matter of finding which one works for you the best & getting to the correct dosage. Narcotics have little to no effect on true nerve pain. Sounds like you may have been enduring a lot of pain that could have been treated & avoided with the correct medication.

You made a very good point about your primary care dr. Very few primary care drs will treat patients with chronic pain long term. They don't want to jump through the hoops the DEA wants them too & they don't want them breathing down their necks telling them what they can or cannot do. I don't blame the drs one bit either. Even pain mgt drs are under the gun as well. As long as these drs do the right thing by crossing their t's & dotting their i's the DEA will leave them alone, however, they all have to follow the same guidelines. Seeing that your primary care is up there in the years you can bet he is not going to be in for the long haul. You would be very wise to get with the other dr & start looking for a pain mgt dr to help you out. You sure don't want to get in a bind one day with the primary care when he has to give you the speech "I can't prescribe these meds to you any longer." Believe me, it will happen eventually.

Yes, the pill mills have been shut down in various states & they are always looking to get rid of any new ones that pop up. Don't fool yourself into thinking the war on drugs is targeted at the pill mills because that is not true. It is worse in some states than others, however, this war on drugs is all about the use of narcotics in the United States, whether legal or illegal. Pharmacists at Walgreens can override what a dr rx's to a patient. He can deny filling the script or even change the amount of pills the patient can have. It does not matter how long you have been treated for your lower back back, length of treatment means nothing. I have been treated for back & neck problems more years than I can remember but again the length of time of treatment has no bearing whatsoever.

Keep in mind there are two types of pain mgt drs. One will do nothing but injections & procedures & no medications. The other will do the same & will also rx medication if deemed necessary.

Take care.

Some pain mangement dr will only prescribe meds or rather depending on your problem, they won't suggest or push for injections. But, if you want injections they will do them.

thanks for the heads up on incompentent trainers, sounds like the one i got!

i am feeling much better about crossing over to the PM person. A little scared and also sad because i have been with my PCP for many years but i think this is for the best.

I'm convinced by the sound reasoning here.

thanks, i have many other issues in addition to this; would love to not use any opiods or any pain meds but don't think topicals can reach all the places it needs to!

appreciate all the input so much.

Dixie6, I haven't tried Zohydro, although I am considering it. Cost is my main concern. Based on what I've heard from a few others, how well it works varies. Two people told me that it works well and carries them the full 12 hrs with no need for bt meds. Two others told me that it didn't work as well as they had expected it to. As with any med, I believe a lot has to do with expectations and what you're use to. If hydrocodone & acet works well for you and the other meds don't or you can't tolerate them, Zohydro might be worth trying. The main problem does seem to be cost. Those who have insurance that will pay for it don't have much of a decison to make compared to those who are running out of options and either don't have insurance or their insurance won't pay for it. I remember Darvocet. The only thing it ever did for me was give me a headache. . LOL. Wish I could have been of help.

Hey Dixie can you take Ibuprofen? If you don't want Hydrocodone with Tylenol and if you can take Ibuprofen then why not go with Vicoprofen ?? I was on that for many years because my doctor didn't want possible liver problems with the high doses of Tylenol I had been taking with Vicodin. Anyway it might be something to consider plus ibuprophen has an anti inflammatory property that the acetominophen does not have so it helps with swelling in the joints.

White Beard