Pain Clinic vs. Pain Management

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skrape
Regular Member


Date Joined Feb 2009
Total Posts : 141
   Posted 7/21/2009 2:20 PM (GMT -7)   
I have read a lot on here about people being seen at pain clinics and by pain management doctors. I have been to two pain clinics and they have not been able to do anything for me. The only things they seemed to do at these clinics were to give injections. The last doctor I saw at a pain clinic told me that he could not do any injections on me because he didn't see anything to inject based on my MRI's. They say the MRI is "clean" and they cannot find anything to inject that they think will help.

What I need to know is if there is a difference between a pain clinic doctor and a pain management doctor. Is there a difference between the two? If I have a "clean" MRI and a pain clinic cannot do anything for me, where should I be going? Where can I find someone that will actually be able to help me?


Skrape
Fentanyl Patch - 100mcgs x 72 hours
Baclofen - 10mg x 8 hours


PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 7/21/2009 2:36 PM (GMT -7)   
Hi, Skrape,
Finding good pain management is a real challenge. A lot of PM's - be it with a "clinic" title or not - are just doing the high tech procedures like injections. You need to find a pm doctor who also prescribes medications, and the best way is probably to call around and ask. I'd explain why you're calling - that the pain clinic you're going to only does injections, and THEY are telling you that's not what you need - so you don't sound like you're doctor shopping for pllls.

In a few cases a PCP is willing to prescribe pain meds, but it depends on what you need. If your PCP has referred you to these clinics, you could call him/her and tell them what the situation is and ask for a referral to someone who does all types of pain management, including medications. But I have found out (the hard way) that some doctors don't even understand this about PM's. So it's not so much the title of "clinic" but the services offered.

One would think that a comprehensive pain clinicl would offer all types of services, but heaven forbid it should be that easy!

Hope this helps a bit.

PaLady

Mrs. Dani
Veteran Member


Date Joined Jun 2009
Total Posts : 2787
   Posted 7/21/2009 2:46 PM (GMT -7)   
 
     Hey Skrape!
 
      Good evenin'! *huggs* Good to see you. What have you been up to? I am getting more and more lazy lazy. My torso "seems" to weigh a ton! What we need are a couple of hott men on call massage therapy OooOOo yea!
 
 
      As to the question of pain clinic vs. pain management... You know I didnt know there was a differance. I just figured it must be an "east coast language" variation of some kind *shuggs*
 
     Im not sure either (wow, im a big help! LOL) about where you should go if a MRI is "clean". My "issues"? Were all clear as day on an xray. I got the "impression" that they wanted to MRI to determine how badly damaged each area was. I could be wrong thou. 
 
     Try back at quare one with your primary care, if possible. I don't know thou. I mean to say... I just really thought everyones doctors were exactly like mine. Horribly nieve I guess. If I ever needed something I went to my doctor and he would order a test or picture... then usually I have to go to XX the next evening meet someone new. shakehead
 
     But, if there is anyway that I can help let me know.  I am sure thou, the other ladies will have ideas! They have alot of knowladge :-)
 
*Huggs*
dani
TWO roads diverged in a yellow wood,  
And sorry I could not travel both  
And be one traveler, long I stood


Tirzah
Veteran Member


Date Joined Jul 2008
Total Posts : 2280
   Posted 7/21/2009 5:02 PM (GMT -7)   
Hi Skrape,
Just wondering who is currently prescribing your pain meds? Maybe you could go back to them & ask them what other options there are.

As for PM's not treating people without something showing, I'm with Dani. From my experience, the PM's at least wanted to know either what was causing the pain or at least where the pain was coming from (muscle, joint, nerves, CNS -- inflammation, physical damage/deterioration, biochemical, etc.). Like Dani, my problems were clear as day from the MRI's. I also had an abnormal neurological exam & a high blood sedimentation rate. I'm not sure how much the injections would have helped anyways since they bring down inflammation. If you don't have inflammation, the shots might not help. My PM will usually try oral NSAID's or steroids first & then if those help, he will switch to injections since they can use a much lower dose as the injection is straight into the problem area.

I'm definitely not questioning whether your pain is real; I'm just saying that in my experience it seems like the PM's don't usually get involved with much unless they know where the pain is coming from. But maybe you need to just keep pushing the issue until you find someone who can diagnose you & set up a good treatment plan. Are the meds you're on not working? It seems like you are on a pretty high dose of Fentanyl. I think that is the maximum dose they can prescribe so perhaps that is part of the difficulty. Maybe you could try to find someone who implants pain pumps to discuss whether that is an option for you. I don't know about them but I know a lot of others have said it helped them.

best wishes,
Frances
Moderator -- Depression Forum


Chartreux
Veteran Member


Date Joined Aug 2006
Total Posts : 9622
   Posted 7/21/2009 6:15 PM (GMT -7)   
First let me address the issue of the MRI, not all Mri places are equal and if the magnet in the machine is not big enough it
it possible to miss stuff, so a clean MRi is not always true, check around for good MRI places and lets face it MRI's can just plain miss things, so it
should not be the only test used...a contrast MRI can pick up on things...

What PALady said is pretty accurate info..I had one Pain Management Doctor who was big time injection freak, so I fired him...

A good Pain Management Doctor, should be able to help with medicines, do procedures, testing and follow throught with physical Therapies
and ect....

Hope this info helps..
Nice to meet you
and lots and lots of soft hugz....
**********************************************
* Asthma, Allergies, Osteoarthritis, Spinal Stenosis, Degenative Disc, Fibromyalgia, Gerd,
Enlarged Pituitary Gland, Sjogren's and Ocular Migraines

********>^..^<********>^..^<********>^..^<********


Jim1969
Veteran Member


Date Joined Jul 2009
Total Posts : 2042
   Posted 7/21/2009 8:08 PM (GMT -7)   
IMHO there can be a big difference between a doc who works at a pain clinic and an actual pain specialist. The doctor they have at the local pain clinic here splits his time between the pain clinic and surgery as he is an anesthesiologist.

As far as MRI's go I agree, not all MRI's are created equal. open MRI's are not as good as closed ones, and a contrast one may show more than one w/o contrast. I am sure the age of the machine makes a difference too as technology is always improving. Of course the possibility is there that there really is nothing to see on an MRI. As good as even the best ones are they still can't see everything.
2 confirmed herniated lumbar discs. Spinal Arthritis. Spinal Stenosis, diabetic peripheral nueropathy.


skeye
Veteran Member


Date Joined Mar 2008
Total Posts : 2976
   Posted 7/22/2009 11:49 AM (GMT -7)   
Skrape,

As Char & Jim said, there are differences between MRI machines. There are two types of MRI machines, a 1T (tesla) and a 3T machine. The 3T machine is much more powerful & sensitive than the 1T machine. According to my doctors, it is not uncommon for something to show up on a scan from a 3T machine, when it did not on a 1T machine, if the area of interest is small, hard to image, etc (this actually happened to me). The 3T machines tend to be at bigger or more specialized hospitals, such as teaching hospitals. The use of contrast & the skill of the people working & reading the scans can also play come into account. But then again, just because the MRI doesn't show anything, doesn't mean that nothing is wrong. Despite all of our technology, there are a lot of things that we cannot see and do not know. Some of the stuff that I have going on is impossible to see with an MRI due to both the nature of the problem & the ability of our technology, but that doesn't make it any less real - more complicated, yes, but less real, no.

I'd talk with your pcp & see if he can recommend you to someone else. Not all pain management physicians are created equal either. Some only do injections & procedures. You might also think about talking with your pcp, or your pain doc about why nothing is showing up on the MRI/what this means (what else could be the source of the pain), and if there is any other type of testing that they could do -- more imaging, physical tests/exam, neurological tests, blood work, etc.

It is so hard when you don't have a diagnosis! Especially when you have symptoms that no one can explain. I know all too well.

hugs,
Skeye

Also, I don't remember if you have explored any of the alternative treatment options, but that may be something that you might want to look into pursuing in the near future. There are a lot of different modalities out there, and many people find them very helpful, although it may take some time to find the right treatment. Sometimes "modern medicine" just can't offer us what we need. I'm a big believer in natural & alternative healing practices. My list of alternative practitioners is almost a large as my list of doctors, and in most cases, the little relief I have gotten has come from the alternative practitioners rather than the MD's!

Post Edited (skeye) : 7/22/2009 12:53:05 PM (GMT-6)


fatherjohn
Veteran Member


Date Joined Feb 2009
Total Posts : 999
   Posted 7/22/2009 7:11 PM (GMT -7)   
Skrape, from my experience there is no difference between a Pain Clinic and a PMS. It all depends on the doctors at each. Some only do injections, others do more including implants. There is only one Pain clinic in the area I live in and they only do injections, no long term medications or implants. Other pain clinics that I have been to do all types of procedures and often have more than one doctor. As per MRIs, Skeye know the technical parts but for me, living in rural areas I have learned something important. I no longer have an MRI in one of the mobile units as I have had to have them redone at the hospital as the mobile units are not as acurate. There is a big difference in the MRIs.  I know that looking for a good Dr. is difficult but I encourage you to find one that specializes in Pain Management. Make sure you do your background work on the dr as all Drs are not equal. Good luck on finding the help you need.

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 13454
   Posted 7/22/2009 11:29 PM (GMT -7)   

Hi Skrape,

I see you have had several people asnwering your posts. Like they say, there really is no difference between a clinic or just a dr alone in practice. It just boils down to what they want people to read on their shingle. 

I do not know if I have asked you this question already or not, but have you considered going to a teaching facility? I know you & I have talked before and I cannot remember is this is somethng you have already done.

Do you have copies of the written reports of your MRI's? If not you really need a copy of the reports for your own personal record. I had totally forgotten about the difference in the MRI machines too. Wow, my brain is just not working too good lol.

I think you already know too that as a rule a PM dr will want a referral before scheduling an appt. Please let us know what you come up with and try to hang in there. I know you have had a terrible time when it comes to drs. This seems to be a trend here lately, seeing more and more complaints about this very thing.


Straydog/Susie
Moderator Chronic Pain
 
crohns disease dx 2002 & small bowel resection, still looking for remission whatever that is, chronic pain 22 yrs, added ulcerative colitis 6-05 to the mix, high blood pressure 28 yrs, aortic heart valve insuffiency, depression, osteoarthritis, osteoporosis lumbar spine, scoliosis lumbar spine, peripheral neuropathy hands & feet, COPD & on oxygen therapy, lupus & decreased circulation in both legs. Several other health issues just not enough room to list it all. Too many surgeries to list and too many medications to list. Currently on 16 different daily medications. Intrathecal pain pump implanted June 05.

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