Interventional Pain DR?

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

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

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

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

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

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.

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

Vin,
That's great news! It's always such a treat to hear that something is really helping with someone's pain!

PaLady