IBS and Pain Management Clinics: looking for advice

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Disce Pati
Regular Member


Date Joined Apr 2008
Total Posts : 61
   Posted 4/9/2008 11:20 AM (GMT -7)   
Hi readers,

I am writing to ask a question for a friend who has IBS. I am familiar with this website through the chronic pain forum but this is the first time I have asked a question on this forum.

My hope is that someone on this board will be able to offer me advice concerning pain management clinics and IBS. I have been treated in a pain clinic for chronic abdominal pain related to pancreas trauma as a result of a couple emergency surgeries I had in 2000. The pain clinic has been the only thing to get me on the road to health after those surgeries. Because of my success with the pain clinic I have been urging my friend to give this a try for his IBS - especially now that his GI doc has virtually abandoned him after promising him treatment. However, he is concerned that a pain clinic will either not take IBS seriously as a painful condition and also brush him off, or that it will not be willing to offer medication (either narcoitc or non-narcotic) and concentrate on behavior modification or other psych therapies.

I was wondering if anyone has gone to a pain management clinic for treatment for IBS and if so, was it helpful? Any advice that you wish to share is deeply appreciated. He is wondering which type of clinic would be most helpful - a tertiary care center / medical school associated clinic or a private, stand-alone center? We are also wondering what is the best way to describe the situation to the doc. Any comments, advice, suggestions or just personal experiences that you are willing to share will be very helpful I believe.

Thank you!

Disce Pati
(learn to endure)

Keriamon
Veteran Member


Date Joined Jun 2005
Total Posts : 2976
   Posted 4/9/2008 12:44 PM (GMT -7)   
I don't personally know anyone with IBS that's been to a pain management clinic, but I have recommended them to some people on here.  A lady I worked with, her husband got agressive prostate cancer and his overall health deteriorated rapidly.  One of his doctors (he had a bunch) finally sent him to a pain management center.  They were very pleased with it because the pain doctor took over all of his medicines and reduced many of them that were pretty much duplicates (what happens when you see many doctors) and got him on some new stuff that improved the quality of his life.  This was not just pain meds, but heart meds, blood pressure meds and a bunch of other stuff.  But the very first thing she did when she saw him was tell him to switch his walking cane to the other side of his body.  I seem to recall he carried it on his bad side, but when she had him switch, he noticed it was easier to walk immediately; it never occured to him to swap sides. 
 
So I'm thinking that pain management doctors are a lot more than narcotics dispensers.  Which, brings me to the part about behavior modfication and psych therapies.  I'm not saying a good dose of pain medicine is not warranted, but I've also recommended to people on this board that they see some sort of counselor because, while stress does not CAUSE IBS, it does make it worse.  And the more IBS you have, the more you tend to stress about it until it turns into a pretty vicious cycle.  A question I have asked before is does a panic attack cause IBS or does getting IBS cause a panic attack?  In many people it works both ways.  So, if your friend does indeed experience stress from his IBS (is there anyone on here who doesn't???), then learning to control and dissapate the stress can actually be helpful.  It in no way means he's imagining the problems or pain, and it doesn't mean he's causing it; it's just a matter of his illness being to the point that it affects his mental health as well.  Also, pain doctors may also prescribe yoga or meditation or deep-breathing techniques because they help people get through the pain better (relaxes muscles that start tightening up due to pain), not because they don't believe the pain is real.  Kind of like lamaze helps a woman in labor get through her pain.  In fact, I would suspect a good doctor would both offer some sort of pain medicine (if not other kinds of medicine as well), AND techniques to help. 
 
In short, your friend should use his good judgment: don't dismiss non-medication suggestions, but at the same time, don't let people tell him that his pain isn't real or that it will just go away if he'd start doing/quit doing X.  I suspect that he will get more sympathy from a pain doctor, though, because they should be rather used to seeing people who have chronic pain but no diagnosis as to why. 
 
If you like your pain clinic, then have your friend try them; most people tend to go to doctors and the like based on personal recommendations, and it seems to work out well that way.  Also, you know they at least know about abdominal/internal organ pain through you.  Your friend shouldn't be a whole lot different. 

Disce Pati
Regular Member


Date Joined Apr 2008
Total Posts : 61
   Posted 4/9/2008 1:13 PM (GMT -7)   
Thanks for your really thoughtful and helpful reply.

The situation you described: the combination of medication and pych therapy, etc is exactly what I encountered in my pain clinic and what I believe makes-up a good clinic. I am hoping that this is what my friend will find - a good, compassionate physician who is willing to stay the course and try different approaches (pharmacological and other non-medication based treatment) to see which is more effective.

Unfortunately he has run into the typical "it's all in your head" attitude or MDs who are unwilling to work with him past the basic steps of "eat more fiber", "learn to deal with stress" and the basic medicatons (anti-depressants, lomotil, etc). I also fear that some pain clinics will take that attitude too - I'd hate to recommend something only to have him go through another demoralizing examination. I truly believe that a good doctor - pain or GI or PCP - can make all the difference for him but it seems like there is no such thing out there in the way our society views IBS.

He is very knowledgeable about the relationship of stress and IBS symptoms and recognizes the vital need to address this aspect. But we feel that sometimes the physical component of an acute flare of IBS has to be dealt with before any kind of mental control can occur. However, I think that the way a pain clinic is able to integrate both medication, psychology and alternative methods is unique to that specialty and I think that these clinics could have a very positive effect for people with IBS. If I had any say in things, I would love to run a pain clinic that specializes in IBS problems....with it being up to date on all the medications available as well as the life style changes and mental support that can make this illness more bearable. I am so frustrated and demoralized by the way my friend has been treated by his physicians - it seems that there should be better alternatives out there.

Thanks for your reply. I find it very helpful - especially your comment about being more accepting of treating chronic pain when no definable cause can be found.

Keriamon
Veteran Member


Date Joined Jun 2005
Total Posts : 2976
   Posted 4/9/2008 2:35 PM (GMT -7)   
I think I understand what you're trying to say about your friend--because he's been dismissed as causing his physical problems by being "mental", non-medication treatments might seem, to him, more of the same condemnation. I wasn't told outright that I was crazy or imaginging things, but my concerns about my gall bladder were dismisssed for some years and I lost faith in doctors in general. Now I have a tendency to double-check anything any of them say through a lot of internet seraching or asking questions here.

Why not ask your pain doctor if he treats people with IBS and what does he think about IBS? If you like what he has to say, then tell him you are going to try to get your friend to come see him and go ahead and tell him that your friend has been so dismissed and talked-down to, that he's jittery about seeing another doctor.  Then maybe offer to go to the clinic with your friend; you don't need to go in with him while he's interviewing, but just be moral support in the waiting room, then he can talk immediately about what the doctor said and what he thinks about him and what he said.   

Some anti-depressants have been found to help IBS symptoms, even where no clinical depression existed in the patient. That's because brain depression doesn't cause IBS, but there are so many bundles of nerves in the stomach that IT can get depressed and out of whack, and certain anti-depressants can make it feel better and work better. So the depression medicine isn't a bad thing to try, only treating your patient like they are crazy is bad.

I'm with you on wishing I could have an IBS clinic. I'd hand out calcium and Welchol samples and spend like an hour with each patient initially to make sure I know everything that's happening with them and then go over all the things they might try to help. And I'd recommend this board!
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