Interventional Pain DR?

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Vin
Regular Member


Date Joined Jan 2006
Total Posts : 312
   Posted 5/16/2009 9:57 PM (GMT -7)   
Hello,
 
Never been to a pain specialist before but I feel I have no choice as the pain ive been suffering for over 7 months now from Lyme has really ruined my life.  First appointment on Monday. 
 
Just have a few questions.    What is the difference between an invterventional pain dr and a regular pain dr, or are they the same?
 
Has anyone here ever been treated for an ongoing illness where steroid therapy or nerve blocks can;t be used?  I am guessing the only thing I can really take is narcotics or something like Lyrica since I can't take NSAIDS because of my colitis/chrons.  They dont work anyway.  What other kinds of things do they do there to relieve pain?  My pcp and my lyme dr only say they will give me ultram(works sometimes) and just deal with it because ul just get addicted to narcotics.  That makes me so angry!!!!  I wish those jerks could see what its like to live one day that im living.  I told them if not narcotics then what else can they recommend for pain besides ultram.  NOTHING! 
 
Ugh, I hope this new dr can help me at least be able to keep my job.
 
Vin
 
 
History:
UC/Chrons - Feb 2004
Panic Disorder/depression - June 08
Lyme Disease - June 08 
Dysplastic Nevus Syndome - birth
Currently: Treating Lyme Disease
Drugs: 6mp 75 mg|lialda 2.4 mg|Paxil 50 mg|Klonopin .25 mg|Trazodone 50 mg|Bactrim|PRN Perc/Tramadol
 
 
 
 
 


PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 5/16/2009 11:32 PM (GMT -7)   
Hi, Vin,
Welcome to the Chronic Pain section, although I'm very sorry for all you're going through. I don't know if I can answer all your questions but might be able to help you out with the first one.

To the best of my knowledge an interventional pm doctor is probably an Interventional Radiologist as far as training goes, but many doctors come to the field of pain management from a few directions. What many of us have had difficulty with is expecting a pain management doctor to offer a variety of options, at least one of which is ongoing medication management (especially if other options have already been tried or may not be able to be used, as in your case) but finding out they only do the interventional procedures. Most of the latter include injections such as nerve root blocks, epidurals, facet joint injections, and others. For some people these can be significantly helpful, or at least partially helpful. I've had a number of them but most haven't helped so I ended up with a double lumbar fusion. Unfortunately, many of these doctors don't prescribe pain medications even though they may advertise as pain management doctors. Since your appintment is Monday, there's no sense calling first to check on this. I'd go, take if possible a written list of your symptoms and other medical records, other procedures you've had that maybe have/haven't helped and discuss your options with the doctor.

One thing that doesn't tend to work out well is if you go in asking for only narcotics because it will look like you a drug-seeking. Instead, list as I said what you've tried, and your response to the treatment or medication. Try to give a good idea of your pain symptoms, and how they affect your life. Explain how you want to work and how the pain is interfering. Hopefully if that doctor doesn't offer the treatments you need, I would ask for a referral to another doctor who does.

It's tough to know in advance as even PCP's and other doc's making referrals often don't understand what a particular pm does or doesn't do. I got caught in this web and ended up with two different pain docs who both only did interventional procedures - which is becoming more common.

Sometimes a pain management specialist will help you find the right mix of medications, and then maybe work with your PCP if your PCP's willing to prescribe as long as you're overseen by a pm doc. If this sounds confusing it is. A lot of us here have a ton of experience dealing with pm docs so we'll try to share our experiences as much as possible.

Unfortunately, I don't know much about what may or may not work with lyme, but yes, your body will become physically dependent upon narcotics - but that's not the same as being an addict. Sadly, there's a lot of misinformation about this, plus a lot of legal stuff doctors can be legitimately afraid of.

IT's late and I hope I'm making sense. Just wanted to add an interventional pm specialist can also prescribe medication; it depends on how they've structured their practice.

If you have more questions maybe someone else can help out, too!

Let us know how Monday goes.

Again, welcome.

PaLady

anice
Veteran Member


Date Joined Apr 2009
Total Posts : 536
   Posted 5/17/2009 1:07 AM (GMT -7)   
Hi, I see PALady got your answers covered. And I am sure others will come and add later. I just wanted to welcome you here. And I do wish you well with your Dr. appt. on Monday. It is a great idea to put on paper your symptoms and what you have tried. Another thing you could jot down are any questions that you may have for him/her. I for one will have a good many questions for days before the appt. and then draw a blank while I am there.

I wish you the best. Feel free to come and post whenever you want or need to. This is a great group of people who have  awesome inputs to share. I think you have come to the right place. Everyone is so caring and supportive.
Anice

Post Edited (anice) : 5/17/2009 2:11:10 AM (GMT-6)


modelmaker
Regular Member


Date Joined Feb 2009
Total Posts : 168
   Posted 5/17/2009 8:18 AM (GMT -7)   
Hi Vin,

PAlady is right on the money defining interventional pain managment docs. Some prescribe narcotics and some do not and will not. That's a matter of their individual practice direction. Of the ones who will prescribe, they do it as a last resort after other logical treatments have been tried and failed.

In addition to the treatement modalities PAlady mentioned, my interventional pain doc also uses CNL or chemical nerve lesioning. He also does the whole gambit of spinal injections some of which are more temporary in nature. He refers out all spinal cord stimulator work but sees it as another viable treatment for some.

Your best bet is to schedule a preliminary consult and discuss your particular problem, what has been tried and the results, and where you are now. DO NOT suggest a treatment such as meds. Your role is to report accurately what you feel and what relief you seek. Let the doc tell you the range of things available to you. He/she may even refer you to a specialist if necessary. Many specialist will not take in new patients without a valid referral. In fact, my interfentional pain doc operates that way.

Good luck on whatever treatment path you select.

Modelmaker
Degenerative disc disease, 4 back surgeries, fused from L2-S1, instrumentation. Being treated for chronic pain. Oxycodone 30 mg. IR. Candidate for SCS in the future.


LLPLUV
Veteran Member


Date Joined Mar 2009
Total Posts : 1158
   Posted 5/17/2009 8:58 AM (GMT -7)   
Welcome Vin
 
So far everyone who has posted has given you sound advice.  I also go to a Pain Specialist and he is a combination.  He did prescribe me pain meds first day so that I would be comfortable during the process of a series of Treatments.  Nerve Blocks.  I also believe these doctors are smart.  They realize addicts will try and use their offices for their next fix.  I noticed they set procedures up and only gave me a  refills to my meds after the procedure and enough to get you through till the next one.  As soon as my series was over I finally recieved a month supply and being told to make an appointment of another med evaluation.
 
Modelmaker is right if you go in and state first off the you want pain meds it will set off an alarm.  But if you just answer his questions which took me over an hour he will get around to asking about medications if he prescribes at this point you can ask him all your questions on meds.  My doc just looked at me and said what pain meds work best and what have they had me on?
 
Addicts have made it hard for us who live with CP.  We have to jump through hoops and always worry if they are looking at us like we are pill seekers.  God forbid if we lose our pain doctor for any reason then we have to start all over again.
 
I wish you tons of luck and hopefully you can get some relief for your pain.
 
Laurie
39 yr young female with,
Chronic Kidney Stones, PKD (Polycystic Kidney Disease), Chronic Kidney Failure, Severe Hypertension, Urological RSD
Also CHF (Congestive Heart Failure) and Sleep Apnea
Hopefully NO MORE........ I think I have it all


Vin
Regular Member


Date Joined Jan 2006
Total Posts : 312
   Posted 5/17/2009 10:09 AM (GMT -7)   
Hi All,

Thanks for responding so quickly. This site is filled with so many knowledgeable people, don't know where i'd be in my treatments without you guys.

I have a journal of all my symptoms already(learned this from my colitis/prednisone episodes in years past). With chronic illness i know changes are measured in weeks/months, not days. And when you are sick and loaded up on up to 12 medications, 25 pills at a time your mind may not be functioning normally.

As far as Monday, I have spoken with this doctor already on the phone and told him what my issues were and what is causing it. I had called 2 interventional doctors before that and they said they don't treat disease, only spinal issues or nerve issues. This particular doctor said he would see me and at least consult with me so I appreciate it.

For narcotics, I meant that when I told my doctors what they had given me for pain wasn't preventing it from majorly inhibiting my life, they said 'the only other thing is narcotics and we don't do that here' or 'i don't want you to get addicted because narcotics is the only other thing i can give you', I just couldn't believe it. First, I can't believe that narcotics are all I have left here. There is NOTHING else besides ULTRAM and NSAIDS and narcotics???? Secondly, I asked what am i supposed to do then and they said 'DEAL WITH IT'. BOTH of them! That is appalling and infuriated me. I swear, I wish there was something that I could transfer my daily pain to them and maybe they would understand that its pretty impossible to function like this. Pain isn't even all, I have to deal with mental disturbances, brain fog, fevers, extreme fatigue,ringing ears, antibiotics side effects, tingling in my face, fingers, and feet, etc. So that is why I felt I needed to consult with a pain specialist, I have to find a way to be able to live like this and still be productive(I have a senior software developer/system analyst). I have shown some improvement with lyme treatment, but not enough where each day still isnt a struggle. I'm pretty lucky I have a great employer and they allow me to work from home sometimes(I take my laptop into the BATHTUB!!). But my work has suffered, and I hate not being as productive.

Anyway, I usually do not suggest anything to doctors unless I know them and we have already tried many things their way. My objective in going to see this doctor is just getting help. And I hope I can add him to my team of doctors who I've been able to find to help.

Again thanks for the responses everyone!

Hope you are all having good days.

Vin
History:
UC/Chrons - Feb 2004
Panic Disorder/depression - June 08
Lyme Disease - June 08 
Dysplastic Nevus Syndome - birth
Currently: Treating Lyme Disease
Drugs: 6mp 75 mg|lialda 2.4 mg|Paxil 50 mg|Klonopin .25 mg|Trazodone 50 mg|WellButrin|Bactrim|PRN Perc/Tramadol
 
 
 
 
 


PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 5/17/2009 1:12 PM (GMT -7)   
Vin,
It sounds like you've got the right attitude, and some good information with your journal. Since this doctor already knows you're not looking for help with spinal issues, hopefully he's a pm who is very knowledgeable about a variety of options.

I know it's a blow to hear "narcotics" for those of us who don't want to be dependent on medications, but many narcotics can be easier on your body for long term pain than other drugs like even NSAIDS. And from my personal experience, it's not the percocent (the narcotic I take) that makes me foggy, it's more likely the neurontin.

You mentioned lyrica, which is the newer medication to help with nerve pain. If that's suggested, you may want to go to the manufacturer's website and read up on it. Your PM doc hopefully has good experience with it, but it's still relatively new (a few years now) and I've found doctors that have prescribed it to me have stayed at too low a dose to be effective. Still, it's supposed to have fewer side effects than the neurontin.

Another medication that also helps with pain but it classified as an anti-depressant is cymbalta. If it works for you it may cover more than one base, as I see you're on paxil. The only reason I'm not taking it is that it created problems with my seizure disorder; otherwise the cymbalta was the only medication that actually made my feet feel normal again. I've got numbness & tingling in both feet, but I'm not a diabetic.

I'm sure you know medications are so individual, and I don't know much about treating lyme, plus with your other medical issues, you do need a team. And I think a pm being on that team would be a plus for you.

Let us know how it goes!

PaLady

LLPLUV
Veteran Member


Date Joined Mar 2009
Total Posts : 1158
   Posted 5/17/2009 2:05 PM (GMT -7)   
Here's another thing for you to think about.  PAlady brought up other meds.  I take Trazodone, Celexa and Klonopin not for depression for I'm a very very optomistic person.  I take it for pain relief.  It helps me sleep and keeps the stress down that I can relax more through the pain.  Plus I take it to help with my blood pressure so I don't cause my CHF to flare up.  Its like they work as an all around calming effect.
 
If you really really don't want Narcotics you can play with anxiety and anti-depressants for pain relief.
 
Laurie
39 yr young female with,
Chronic Kidney Stones, PKD (Polycystic Kidney Disease), Chronic Kidney Failure, Severe Hypertension, Urological RSD
Also CHF (Congestive Heart Failure) and Sleep Apnea
Hopefully NO MORE........ I think I have it all


Becoming undone
Veteran Member


Date Joined Jul 2007
Total Posts : 927
   Posted 5/18/2009 11:21 AM (GMT -7)   
Hello Vin,
I have crohn's myself. I know the difficulties of finding proper meds...and the stigma attached to some types of meds. However, they have given me some of my life back. If you are on a low enough dosaged, brain fogginess is not as much an issue as dealing with the brain detriment caused by constant pain. Also, I found the steroids were far worse on my brain than pain relievers ever could be...I use the durgesic (the patch), and it helps a lot...it bypasses the GI, and it helps to slow and control my fast moving GI system (usually causes constipation in those with normal GI tracts, but causes me to slow down...not quite to normal but a heck of a lot closer)...
I hope you can find success in your treatment...
"The earth laughs in flowers"


Vin
Regular Member


Date Joined Jan 2006
Total Posts : 312
   Posted 5/18/2009 10:44 PM (GMT -7)   
Hi everyone,

I saw my new pm dr today. besides waiting an hour(everyone there said its usually not that bad), it went rather smoothly. He seemed like a knowledgeable guy and understood both of my diseases especially the lyme(a rarity in the medical community). I told him my pain patterns and he decided that i sholud be on something around the clock because my pain while not everyday, is most days and you would rather prevent it rather than react to it. I would tend to agree, but in the future I am going to want to talk to him about coming off the medication to see where my body really stands and if the lyme treatment is really working. He gave me celebrex which is an nsaid, but he said its least intensive on the bleeding of the nsaids so I will try it. he also put me on 100 mg of a new tramadol drug called ryzolt. It just came out and apparently works in an immediate and extended release fashion at the same time. sounds cool to me. and for breakthrough pain he gave me percosets. I think that will cover my bases while i am being treated for lyme and hopefully i won't be one of the unlucky ones with chronic lyme. Last june I was only taking one 10 mg lexapro tablet a day, and now, almost a year later, i cannot believe what has happened. Did i really get so old this fast? I am only 27. I keep saying "just one more month, just one more month" :(. In the meantime, i'm glad I have been able to get a nice team of doctors to help me. :).

Night everyone.

Vin
History:
UC/Chrons - Feb 2004
Panic Disorder/depression - June 08
Lyme Disease - June 08 
Dysplastic Nevus Syndome - birth
Currently: Treating Lyme Disease
Drugs: 6mp 75 mg|lialda 2.4 mg|Paxil 50 mg|Klonopin .25 mg|Trazodone 50 mg|WellButrin|Bactrim|PRN Perc/Tramadol
 
 
 
 
 


PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 5/18/2009 10:50 PM (GMT -7)   
Vin,
It sounds like you had at least a fairly positive experience with your new PM doctor. Some doctors run on time, but I've found pain management doctors, orthos and neurosurgeons to be the worst. Usually packed waiting rooms. So if he's good just bring a book!

Give the strategy of medications a good try.

Keep posting with us if you want to!

PaLady

L5-S1 Radiculopathy
New Member


Date Joined May 2009
Total Posts : 11
   Posted 5/19/2009 7:52 AM (GMT -7)   
Vin:

You need to see a board certified physiatrist. They are pain specialists qualified to perform pain interventions. Narcotics have provent to be reliable and effective in treating pain if administered under approved protocols. Doctors who view them as risky, poor or negative treatment options have not kept up their reading of the literature.
1988 - L4-5 herniation
2006 - Partial Laminectomy with Components of Cauda Equina Syndrome L4-5] (left side)
2007 - Minimally Invasive Spinal Fusion L4-5
2008 - Right-side radiculopathy L5-S1
Standing order for epidural/nerve blocks & monthly Percocet refills


Vin
Regular Member


Date Joined Jan 2006
Total Posts : 312
   Posted 5/19/2009 3:32 PM (GMT -7)   
I am definatly going to give this a try. At least now i am on a schedule, not 'take it when u feel like it', i have a new tramadol type drug, and percosets for backup which im glad for so I don't have to worry about the really bad days because they in the past have always been able to work.

I go back to see him in a month. I figure I'll know within a week or 2 if this strategy will work. He also said if i am still having tingling in my face, fingers, and feet he is going to want an mri to see whats going on in there in case its not related to lyme or if its cysts related to lyme. scary!

Vin
History:
UC/Chrons - Feb 2004
Panic Disorder/depression - June 08
Lyme Disease - June 08 
Dysplastic Nevus Syndome - birth
Currently: Treating Lyme Disease
Drugs: 6mp 75 mg|lialda 2.4 mg|Paxil 50 mg|Klonopin .25 mg|Trazodone 50 mg|WellButrin|Bactrim|PRN Perc/Tramadol
 
 
 
 
 


Vin
Regular Member


Date Joined Jan 2006
Total Posts : 312
   Posted 5/19/2009 3:37 PM (GMT -7)   
Becoming undone:

For sure, prednisone might have been the worst drug ive ever taken. I HATE IT! There is nothing quite like being on 50 mg of oral and over 80 mg of IV! I am so glad that I am off it now. I mean, it has saved my life and i'd much rather have those side effects then the effects from the chrons/colitis, but its just a rugged drug and destroys your body. I've been on it numerous times for upwards of over a year. I have been off it this past episode for about 2 months now.

Vin
History:
UC/Chrons - Feb 2004
Panic Disorder/depression - June 08
Lyme Disease - June 08 
Dysplastic Nevus Syndome - birth
Currently: Treating Lyme Disease
Drugs: 6mp 75 mg|lialda 2.4 mg|Paxil 50 mg|Klonopin .25 mg|Trazodone 50 mg|WellButrin|Bactrim|PRN Perc/Tramadol
 
 
 
 
 


Vin
Regular Member


Date Joined Jan 2006
Total Posts : 312
   Posted 5/22/2009 9:55 PM (GMT -7)   
Update:

I think this combo is working! The ryzolt and the celebrex SEEM to have taken alot of the edge off the pain. Now i can't be sure because I've gone through lulls before where I wasn't taking anything at the time and the pain seems to cycle with this disease, but for about 3 days i haven't had any pain above a 6! I've been able to focus more at work, and jog, and go out! I've only needed the percoset once!. I am just happy right now for some relief. :)

Vin
History:
UC/Chrons - Feb 2004
Panic Disorder/depression - June 08
Lyme Disease - June 08 
Dysplastic Nevus Syndome - birth
Currently: Treating Lyme Disease
Drugs: 6mp 75 mg|lialda 2.4 mg|Paxil 50 mg|Klonopin .25 mg|Trazodone 50 mg|WellButrin|Bactrim|PRN Perc/Tramadol
 
 
 
 
 


PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 5/22/2009 10:09 PM (GMT -7)   
Vin,
That's great news! It's always such a treat to hear that something is really helping with someone's pain!

PaLady

uniquelyme
Veteran Member


Date Joined Nov 2008
Total Posts : 1037
   Posted 5/23/2009 10:41 AM (GMT -7)   
 
 
Vin,
 
 
Interventional pain management uses injections of drugs to reduce pain. Besides its therapeutic benefit, interventional pain management can play a role in identify the source of the pain.
 
I found this at this site: http://www.csmc.edu/7105.html
 
Me.

 I hate Boats!!!!
 
Post Lamenectomy Syndrome, Spinal Stenosis, DDD....
1999 Hemi Lamenectomy/2005 Spinal Fusion(L4-S1)
Methadone 120 mg. a day/15 mg. Oxycodone as needed(up to 4 x a day)
High Blood Pressure: Lisinopril HCTZ 10 mg. daily
Type 2 Diabetes: (March 16, 2009)
Metformin HCL ER 1000 mg. at night..Glipizide 5mg. 2X in the morning
                                                                    

 

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