I have had the good fortune to have a couple of great PM's. I had RSD in my right arm and shoulder from a botched shoulder surgery and the PM that I saw was incredible. He did everything he could and then some to manage the pain of RSD. I never had a drug screen, never was questioned on the authenticity of the pain that I was in. I was very fortunate after almost 8 years of suffering, the RSD went into a kind of remission of sorts, and I was able to stop meds. Now, after my failed back surgeries, CES and the resulting permanent nerve damage, I have two more great PM's. The first one treated me for the first two years, and he moved to Puerto Rico. He still calls my new PM and talks to him about me, and how I am doing. My new PM is a good guy too. He treats the pain as best he can, and he takes what I tell him into how things are going. Luckily , by the time he came along, my former PM and I had gotten my meds to a point where they were working as well as they seem to be able to for me, and he manages things pretty well. He agrees with me, no more injections, no more PT, it only makes the nerve problems flare even more, so we make do as best we can.
I have never had a urine screen but would do it if asked without hesitation. I don't have a contract, never have in fact.
I guess I look at it this way, if that is what it takes to make my doctor comfortable enough to continue to prescribe the meds that I need to function as best I can, so be it. I don't ask for meds early, even on my worst time periods, if I need an adjustment, I call him and tell him.
PM is a two way street, you have to work with the doctor, and the doctor has to work with you. If there is mistrust on either side, the relationship isn't going to work. Pain management is not a race to the finish line, it is a marathon, and you have to work with the protocals to find a combination of meds and whatever else that is going to work best for you. However, you have to understand that patience along the way, and time are essential in building a good pm relationship.
Just my thoughts,
PLIF/TLIF Fusion w/Instrumentation L4-5 Spondololysthesis L4-5.Laminectomies L4-5, foraminal stenosis L3-4, L4-5, L5-S1, herniations L3-4, L4-5, L5-S1, central canal stenosis L3-4, L4-5 and L5-S1
POST OP CES 3/30-06
Neurogenic Bladder and Bowel, bilateral numbness legs and feet
Revision for failed Back surgery, pseudoarthrosis L4-5, hemilaminectomies L3-4, L4-5, L5-S1, bmp added to revision fusion, replaced two bent screws that were reversing out of vertebrae - August 2, 2007
On going back pain and neuropathic pain, failed back surgery, consult for scs, decided not to do that at this point.
Adhesive Arachnoiditis also......just what I didn't need..9/08- adding bilateral ulnar neuropathy with severe compression to the mix. They want me to see a surgeon for ulnar nerve surgery, but I'm not biting.
I've seen enough surgeons over the last few years.