seeing a pain management dr for the first time. HELP

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tainky
New Member


Date Joined May 2009
Total Posts : 4
   Posted 5/31/2009 1:22 PM (GMT -7)   
I have severe psoriatic arthritis and was taking Humira injections for that.  Apparently that drug caused MS and lupus.  My rheumatologist says his hands are tied and doesnt know what to give me for the pain so he is referring me to a pain specialist. Cortisone shots and the "all over" shot that he gives me doesnt do anything.  It think that is some kind of steriod shot.  He talked about nerve blocks and different injections.  Honestly it scares the hell out of me. Anyone have any ideas or have seen a pain specialist to let me know what to expect?
 
 

skeye
Veteran Member


Date Joined Mar 2008
Total Posts : 2976
   Posted 5/31/2009 4:56 PM (GMT -7)   
Hi Tainky,

Welcome to the CP board of HW! This is a great place to come to receive and give support as well as experiences. We are a very close knit group, and love to have new members (although we always are sad to see another person in pain) While none of us are doctors, together, we have a great wealth of knowledge from our shared experiences with pain of all types. However, our experiences & advice should never replace that of a doctor. That being said, on to your questions, etc.

First, let me say that I am so, so sorry that your arthritis medication caused MS & lupus. Besides having to deal with the pain & disabilities associated with arthritis, just one of those conditions would be devastating, but two?! Wow. MS is something that is still "on the table" for me (although currently it is lower down on the list). I know how terrified I was, even to have MS suggested! There are both MS & lupus boards here on HW (as well as arthritis) & you may want to check them out as well as they can probably give you some better 'disease-specific advice!'

As for pain management. There have been many threads about pain management & pain management physicians, etc in the past. You may want to search through some of these -- just hit the search button in the control panel & type in a key word, such as pain management. We often use the abbreviation "PM" to mean pain management, pain management clinic, pain management program, clinic, etc, as fits with the context. Most of us here are patients at PM clinics, although for some of us (me included), another doc, such as our "pcp" (primary care physician) or neurosurgeon has taken charge of our PM.

Your doctors may have already told you that many, if not most PM clinics only accept new patients with a referral (this was the case with mine, during the time in which I was a patient at a PM clinic). Ideally, you want to see a PM physician who is board certified in pain medicine. Often times, these are anesthesiologists or neurologists that have continued their training to specialize or become board certified in PM. Some practices also employ nurse practitioners & physician assistants, who you may see once you have established a plan with your PM doctor. That being said, not all PM clinics are equal. Some only do pain relieving procedures (injections, nerve blocks, etc), whereas other do both procedures AND prescribe medication. Ideally you want a clinic that does both. Different medications are used for pain, and likely, you will be put on a combination of medication. Examples of classes of medications used in pain management are anti-depressants (such as cymbalta and amitriptylene/elavil) - these anti-depressants are known to reduce nerve pain, anti-seizure medication (such as gabapentin/neurontin and lyrica) is also commonly used to treat nerve pain, muscle relaxants (such as zanaflex, which in addition to helping musclar pain, is also known reduce the amount of pain signals received by the brain), and opioids (your "traditional" pain medication, such as morphine & oxycodone). If you are prescribed an opioid medication, you are generally required to sign a "pain contract." The details of which vary slightly from PM to PM, but these contracts basically state the "rules" which you must follow in order to take this medication. Depression & sleep problems are very common with CP, so your PM may start you on medication for this as well.

Generally, before PM's resort to long term opioid use, they first exhaust all other options, including other medications & non-invasive procedures. At the time in which you are placed on opioids, depending on the nature of your pain, you may be prescribed both a long acting medication, and a short acting medication for "break through" pain.

I think this covers just about everything, but I'm sure others will be by to welcome you & add some more thoughts! Good luck & keep posting with us!

Skeye

Piercings
Regular Member


Date Joined Aug 2008
Total Posts : 326
   Posted 5/31/2009 5:46 PM (GMT -7)   
Skeye pretty much hit everything that I could think of to tell you, so I'm going to leave it at "Hi, glad to see you but not glad why you're here." And of course..."Welcome"

Also how did you like the Humira as far as effectiveness? I've been pondering it as I have psoriatic arthritis as well.

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 13481
   Posted 5/31/2009 7:45 PM (GMT -7)   

Hi Tainky,

I too want to say welcome aboard. Skeye gave you an awesome amt of info on the pain mgt dr situation. Try not to get too stressed out. Your first appt with be an evaluation and he/she will go over everything with you, and try to come up with a treatment plan. Its all a hit and miss type thing with pain mgt. None of us are alike even tho we may have the very same symptoms. Same with medications, may help me but do nothing for you.

I suggest you make a  list of questions that you want to ask the dr. That way you will not forget something and be on the way home going, oh darn, I meant to ask that question. Be sure you understand what the dr is telling you and do not be afraid to ask questions. Remember he is there to help you, and you are paying him to do just that.

WOW, MS & Lupus-what a combination. I have medication induced Lupus too. Mine was caused from Remicade infusions that I did for my crohns disease. I am now on Humira shots and it does help my crohns, much better than Remicade ever did. I was on Remicade 3 1/2 yrs and went every 4 weeks for an infusion. My rheumy has me on Plaquenel for the Lupus and since I am on Humira I have to stay on it. I started out on 100 mg but he is getting ready to bump it to 200mg.

Hang in there and try not to stress over this appt. If you think of anything else be sure to post it. Everyone is real good about helping out here on this forum.

Susie



Morgoth
Regular Member


Date Joined May 2008
Total Posts : 177
   Posted 6/1/2009 9:28 PM (GMT -7)   
Welcome. Topic is covered I guess.

Look at he bright side. You're already in a lot of pain, so things can only get better right? Don't expect miracles but things will improve. Relax, have a bit of patience (I know this might be difficult when in pain) and share your thoughts and pains with the boys and girls on this forum.

Take care.
To stand and be still at the Birkenhead Drill is a mighty bullet to shew.


PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 6/1/2009 11:34 PM (GMT -7)   
Hi, Tainky,
I also wanted to welcome you to the chronic pain forum, although I'm sad to read all you're dealing with. I'm glad you came here, but there's not much more I can add to the great responses you've already had. Skeye and straydog gave you some wonderful details. Feel free to ask any questions that come along, but as straydog said try not to get too stressed out - but I know that's easier said than done.

Having a list of questions and your symptoms is helpful, because if you're at all like me there's so much I know I'd forget if it wasn't written down. And make sure your medical records get there in time for your visit. Since sometimes things don't get send as they should, I try to get copies of most of my records and take copies in hand just in case they've not arrived on time.

Welcome - and good luck with your first visit.

PaLady

Tony McGuire
Regular Member


Date Joined Feb 2009
Total Posts : 483
   Posted 6/2/2009 3:36 AM (GMT -7)   
PAlady said...
Hi, Tainky,
Having a list of questions and your symptoms is helpful, because if you're at all like me there's so much I know I'd forget if it wasn't written down. And make sure your medical records get there in time for your visit.
PaLady


I do somewhat the same, but we are under a 'managed care' system here. Everybody has a computer, and other than 'third tier' providers, every doctor can get directly to my most current record.

That leaves just prescriptions. So, I keep my prescriptions typed up and color-coded doctor to precription, with daily dosage and pill weight. Doctors' names in color, along with phone # to make it easier for one physician to contact another.

I keep this on a card that is about 3"x5" and manage it in WordPerfect. You wouldn't believe the cooperation I get for supplying that silly little card of current prescriptions. My PM spent half of our last appointment typeing all my meds into the system (15 pills at various times/weights).

I give one of those cards to everyone I meet with. PM, PCP, Pediatrician, you name it. Some say they don't need one, but I lay it on their desk anyway. And from that, every doctor learns my name and prescriptions much faster.

Once you start it, however, don't think they'll let you stop.
Wife: Liz, the choice of a lifetime
Dogs: Koshka Prayer & Chomp Prayer
Meet My Wife And Me

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