Done with Pain Management...for now.

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misterkatamari
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Date Joined Jan 2011
Total Posts : 374
   Posted 7/19/2011 9:43 AM (GMT -6)   
So I saw my pain doctor after getting all 3 injections, and none of them really helped much. I really like my pain doctor, but I am starting to think perhaps that even he doesn't really understand the full extent of the pain I'm in.

He wrote me a prescription for Tramadol, said I was welcome to come back if I felt something else would help me there--like another injection later on. He said, otherwise, my PCP can just keep me up on the Tramadol if I want them to. He also said that he was going to refer me back to the neurosurgeon that referred me to him.

The thing that is confusing to me is that he also said that I was not a candidate for surgery, no questions in his opinion. Obviously, he isn't the neurosurgeon but it concerns me. If I can't get surgery, and my pain doctor acts like he doesn't really have any more resources that I could benefit from...what the heck am I supposed to do?

I mean, hopefully the Tramadol he prescribed helps but if not what exactly am I supposed to do? Maybe I can ask the Neurosurgeon that.

--Edit-- Also, does anyone have any experience with Tramadol? I'm not quite sure what to expect. He told me to go ahead and take it 'when I feel pain'. Which made no real sense to me, because, well, I am always in pain. It isn't like sometimes I feel really good and then it hits me. Its constant, gnawing, drilling pain. So by what he said, I would end up taking it every time the medicine wore off basically. lol! (I always follow the directions on the bottle, I am just saying that I am not sure why he said what he did.)

Post Edited (misterkatamari) : 7/19/2011 9:47:07 AM (GMT-6)


Monty's Mom
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Date Joined Aug 2010
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   Posted 7/19/2011 9:52 AM (GMT -6)   
misterkatamari,

I had this problem too with a group of pain management doctors locally. What my PCP and I did not realize when I went there is that there are PM doctors who only do injections, nerve blocks, or other procedures without continually prescribing your pain medications. They recommend changes that you then must get from your PCP or surgeon.

I understand your confusion, and it was terribly frustrating for me. What my PCP and I did was make a plan. She agreed that I could call every pain management doctor in the area where I live and ask first if they do continual medication management and prescribe the meds, and if they take my insurance. If they answered yes to both, then I wrote down what they required from my doctor for a referral and their process of getting an appointment. Most of the time they needed the doctor to fax records and refer me to them. I called my PCP, they did the required paperwork, and within 2 months I had an appointment.

This may take some time sadly. What I would do is call your neurosurgeon or PCP and either talk to them, their nurse, or make an appointment to explain the circumstances. There are doctors out there who do the medication management for their patients, but you have to look for them and ask specifically for that.

I hope that you find a doctor or medication to help you soon. You are in pain and should be heard. At times though, you must be your own loudest and most insistent advocate to get pain control. Keep calling, making appointments if you can't get through or are not getting relief, until you find what works for you.

Good luck, hope this was helpful.
Monty's Mom

misterkatamari
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Date Joined Jan 2011
Total Posts : 374
   Posted 7/19/2011 10:01 AM (GMT -6)   
Thanks a ton, Monty's Mom.

I'm going to go ahead and make an appointment with my PCP when I can and explain the situation and just get a general check up while I'm at it. If they act like they are having issues with prescribing the medication, then I'll call the pain doctor back.

My main concern right now is that I'm not quite sure what I am supposed to do if nothing else helps with the pain. Just take drugs my whole life? The doctor acted like he was just not sure why I was in so much pain even with the injections, and he was sorry the injections didn't help...but other than the Tramadol, he didn't offer any other alternatives.

Maybe I'll see what the Neuro doctor says. Perhaps they'll want me to do physical therapy or something, I don't know. I just want to make sure I keep up on this because I can't function unless I keep this stuff in check!

straydog
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Date Joined Feb 2003
Total Posts : 16290
   Posted 7/19/2011 10:54 AM (GMT -6)   
Hi Mister, Mindy is right, there are two types of pain mgt drs out, one will do procedures & injections only, no medications as a rule, the other will do the same but he will also write a script for pain meds, perhaps a muscle relaxer if he feels they are warranted. It sounds to me like you got in to a procedure only dr.

If this were me, I would go online to my health insurance web site and pull up PM drs that is listed and call them and find out if the dr will rx meds as well as procedures. Write down what is needed to get an appt which is usually a referral from your dr, a PCP can do this and copies of your medical records. You will not sound like a druggie looking for drugs by asking if the dr rx's meds, just say you know not all PM drs write scripts. Take the list of who does write scripts to your PCP and get a referral. This will keep you from being sent to someone like what you have now for a PM dr. By doing this much on your own it will help the drs office out and get you into someone sooner. Also, you can go to Drugs.com and read up on Tramadol and find out any info you need. I know some of the members here at the forum are on it. Its one of those things it helps some people, then some it has no effect on their pain at all. But, that is also how medications work.

You said you were referred back to your neurosurgeon. Did he at any point ever talk about surgery with you. I will be honest i cannot remember what your medical condition is, whether its your neck or back or both that is giving you problems. Most people only resort to surgery as the last option and not everyone is a surgical candidate. Having surgery is not a guarantee of improving your situation either. The people here at the forum that have had surgery obviously did not have the outcome they had expected or else they would be out living their life not hanging out in a CP forum. Unless you are in need of surgery your neurosurgeon is not going to keep you on as a patient because surgery is where he makes his money. But, he could assist you in getting in to see another PM dr.

I totally understand your thoughts of not wanting to be on medication the rest of your life, none of us ever wanted that monkey on our backs. But, if that is the only way to have some quality life then it is certainly something to consider. I can assure you I never in my wildest moments ever thought I would have a pain pump implanted in me back in 1995. I would have laughed in your face if you had told me this before having it done.

Many times we do have to advocate for our own care and thats ok too. People do need to take an active interest in their care and not totally rely on some dr to fix everything, its just not possible. There are lots of things we can do to help our situation. Just don't give up and decide well this is it because of what your current PM dr is telling you. Sometimes we find ourselves seeing more than one PM dr to find the one that fits, the one that cares and is interested in me as a patient and not as a cash cow.

Take care and let us know how it goes.
Moderator Chronic Pain Forum

misterkatamari
Regular Member


Date Joined Jan 2011
Total Posts : 374
   Posted 7/19/2011 2:07 PM (GMT -6)   
Thanks Straydog, you're always helpful. lol!

My problem is severe pain due to a herniated disc. I guess I actually have 2 herniated discs and one bulging one, as well as mild/moderate scoliosis and maybe arthritic changes in my facet joints. No neck pain--thankfully--'just' back/left leg pain. It is just so bad and constant. I did take the Tramadol today, however, and seemed to actually help a bit. It is weird because it is lasting WAY longer than the Vicodin did and seems to be helping me more? Hopefully that continues.

But yeah, they don't want to operate unless a last resort. I just wish I had more concrete ways of getting better, because I want to know what my outlook is for the future. The reason the neurosurgeon really doesn't wanna operate on the herniated disc (discectomy) is because of my scoliosis. The herniation is at the most severe curvature of the spine, meaning that they would need to--his words--'do some major reconstruction', including fusion at various levels of the spine. I'm also 22 years old, which is a big reason why they don't wanna do something major like this and then have bad--or just not any--results.

Dagger
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Date Joined Apr 2008
Total Posts : 1522
   Posted 7/19/2011 2:39 PM (GMT -6)   
Tramadol helps some types of pain better than others. Some love it some hate it. Many don't consider it a narcotic but it can make you feel high, it can be addictive, it can cause physical dependence, and if you take it for a while, you may have rather severe withdrawal symptoms when you stop.

Tramadol can interact with other drugs such as antidepressants and some OTC meds and herbs. Go over to the fibro forum and look in Fibro 101 for the section about serotonin syndrome. It's unlikely to be a problem for you but it is a great idea to know the symptoms.

I find that tramadol lasts a lot longer than other pain meds. Did your doc prescribe it for you to take regularly or as needed? Take the minimum amount possible so that you don't build up a tolerance too quickly, especially if you expect to use it for years.

If possible get another opinion. Be careful though, you can always find someone willing to do surgery even if it's not the best option for you.

Monty's Mom
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Date Joined Aug 2010
Total Posts : 664
   Posted 7/19/2011 3:56 PM (GMT -6)   
Dagger is right, be careful of a surgeon that jumps to perform surgery without exploring other options first. Do what is best for you. Sometimes that means medications to manage it, like I am on, combined with physical or aquatic therapy, stretches, exercise, or rest. Sometimes injections work alone or with meds, or surgery fixes it. Each person is different. Sadly, it took 2 years to find out what mine was, and another year to find out that it was life-long and only meds will help with surgery during acute times.

I hope that is not the answer you get, but either way we are here to help. I am glad that my post helped you.
Mindy
The worst sin towards our fellow creatures is not to hate them, but to be indifferent to them. That's the essence of inhumanity. George Bernard Shaw
Pelvic adhesive disease, IBS, SI pain, arthritis, kidney stones, depression, 10 pelvic surgeries for pain, ovarian cysts, adhesions, endometriosis, adenomyosis, and possible ovarian remnant syndrome. Unexpectedly growing ovary #3 on right side.

straydog
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Date Joined Feb 2003
Total Posts : 16290
   Posted 7/19/2011 4:34 PM (GMT -6)   
Mister from what your neurosurgeon says I would have to respect his opinion. It sounds like he is a good surgeon and an honest one. If you are comfortable with what he says as far as the surgery goes, and yes, when there is scoliosis involved depending on the curvature fusions are required. I really have some healthy respect for this guy. There are others out there that would tell you something different anything to get you on an operating table. Problem is they would not be looking at the big picture with you.

I would discuss the possibility of another PM dr with the neurosurgeon, at least ask him what he thinks the next step should be. You are so young to be having these problems, and many drs do use your age against you. Problem is pain has no age limit. I do not know what all you have done to date treatment wise, but I have to believe there is something that can give you at least temporary relief.

My understanding is they have indeed re-classified Tramadol and it is now considered a narcotic. As one of the other members pointed out try maintaining on the lowest dose possible. Keep in mind CP never goes away, and you will always have some sort of pain, shy of a miracle happening. I have a pain pump and I still have pain but it is more tolerable with the pump.

Let us know how things go.
Moderator Chronic Pain Forum

chanterelle
Regular Member


Date Joined Apr 2011
Total Posts : 99
   Posted 7/19/2011 6:19 PM (GMT -6)   
Unfortunately Tramadol does nothing for me. I feel no different when I take it at all. I really hope it continues to work for you! Apparently it does help many.
Back injury 2007 with 3 herniated discs, IT band syndrome, myofascial pain, DDD.
Diagnosed with Celiac Disease February 2011.
Diagnosed with Fibromyalgia April 2011.
Insomnia forever but worse the past few years due to pain and discomfort.

sjkly
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Date Joined Dec 2007
Total Posts : 2113
   Posted 7/19/2011 8:00 PM (GMT -6)   
Tramadol is the only pain medication that I take.  I am nieve to narcotics-have never taken them due to hypersensitivity to codiene.  Tramadol is metabolized differently than codiene so my doc thought it might be a good option for me.  I take it when I need it and it works really well and the effects last a lot longer than the 4-6 hours between recommended doses.
 
What surprised me most was that when my ankle swelled up recently (this happens periodically and is one of the most painfull things I ever experience) I took a tramadol (first time I have had this happen since getting the tramadol) and it worked.  Nothing has ever helped with that foot and ankle pain.  I went from really hurting, thinking I would not be able to sleep-or walk the next day-to pain free in twenty minutes.
 
Now, I know that it won't work like that for everyone but I love having tramadol in the house-just having it here lets me be confident that there won't be things I just can't do because of the pain.

southviewgirl
Regular Member


Date Joined Sep 2010
Total Posts : 64
   Posted 7/19/2011 9:05 PM (GMT -6)   
Hi, I know what you're going through. From what you describe regarding your pain and where it's located, that is part of what I am going through as well. I have had scoliosis since I was 7, I'm now 30. I've had 9 spinal surgeries, fusions, fusion repairs, hardware removal, more fusions. Now what I'm left with is left leg pain and back pain. It sucks, I know.

Now as far as the doc situation, I've been there too. It took me a long time to finally find a great dr who listened to me and was able to understand my pain. I was told by my surgeon once that doctors, now not all but some, think that surgery fixes the problem and no more meds are needed after recovery. Now obviously you and I, and everyone on this site and all over the world with chronic pain, knows that's not true. Sadly, it takes time, and constant persistence, calling, making appointments, etc. But the good news is once you get a dr who truly understands your unique situation, it makes going forward so much easier.

First off, I would call the pain dr back and maybe make another appt to discuss what his recommendations are for you now since the injections didn't work. Then I would look for another pain clinic.

I don't have much advice on Tramadol, unfortunately I'm allergic to it, so the only thing I remember from taking it last time was my neck and jaw locking up and had difficulty breathing. No fun. I have heard from others that it either works or does nothing, so if it works for you, that's great.

Best wishes on getting this all figured out.

misterkatamari
Regular Member


Date Joined Jan 2011
Total Posts : 374
   Posted 7/20/2011 8:37 AM (GMT -6)   
Wow, thanks for all the great advice everyone.

I don't want to jump into surgery either, so perhaps depending upon what my Neurosurgeon says on this next visit I will ask him about long term PM or other options--if he doesn't suggest it himself. I have also shown my MRI and X-Ray to my cousin who is a surgeon, and he showed them to some co-workers who are neurosurgeons. They all basically agreed with my neurosurgeon's opinion, so that helped me feel a bit more confident in it.

I'm taking the Tramadol as needed, which so far means I have taken it once or twice a day. It's 50 mg with no added stuff like Tylenol.

But yeah, thanks again for all the responses. I am doing ok today, I did take some of the Tramadol when I woke up because my leg was giving me issues. lol!

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 16290
   Posted 7/20/2011 9:54 AM (GMT -6)   
Mister that is great that you have a relative that is a surgeon and he took your MRI's to his buddies for reviews and comments. That really is an plus. At least you know there are others that agree with your surgeon and you do seem to be comfortable with him. I think you are wise to hold off as long as you can on having surgery, sometimes one surgery leads to another and on & on. If you ever reach the point of no return you will know when you need to make a decision and I don't thinks its now either. Stay as conservative as you can. Be sure your neurosurgeon is aware there are two types of PM drs out there, not all drs are aware of this in the PM field.

Lets hope the Tramadol keeps working for you. When do you see the neuro again? Take care.
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