My first PM appt was today...

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Mysti
Regular Member


Date Joined Jul 2011
Total Posts : 101
   Posted 8/29/2011 6:20 PM (GMT -6)   
Well, today was the day I have been waiting for and I really need to vent.  I've had this appt for over a month, after being treated for pain by my PCP for the past 5 yrs for my back pain and right leg sciatic pain...I won't go into all that again, but as I've posted before, the pain has begun to escalate significantly the past few weeks.  I've been taking hydrocodone 10 mg 3x day, flexeril 10mg every 6-8 hrs as needed, and Lyrica 75mg twice daily.  My MRI from last month indicates 3 bulging discs, degenerative discs, facet arthritis, osteophytes.  After the MRI, my PCP referred me to an orthopedic surgeon.  However, I had heard several negative references on that particular ortho dr, so I chose to instead ask my PCP to send a referral to the "spinal specialist" that my brother has been using for years....who just happens to be a pain management physician.  I had already filled out all my paperwork, which included signing a pain contract and the paperwork had info about the PM doc prescribing long-acting meds etc.  I even had asked earlier if he would take over rx-ing my pain meds and I was told yes, he would, if meds were indicated in my case.
 
Ok, so my appt was this morning.  The dr. was nice, seemed compassionate and he went over my diagnoses about the discs in my back, which wasn't anything I didn't already know.  He said he thought I would benefit from the epidural steroid injections and told me his office would contact me in a couple of days to schedule the procedure, after verifying with my insurance etc.  He also told me he would NOT be giving me any scripts today, as he preferred that PCPs continue to rx if they are already doing so...if not, then he would do it, but he felt like what I was currently taking was sufficient.  I was a bit surprised by that, as I guess I thought he might start me on a long-acting opiate instead of the hydrocodone...which was no longer working, and thus the whole reason I was seeking further help.  In fact, when we were discussing my recent increased muscle spasms/cramping, I told him that I didn't think Flexeril was helping and that I thought it was making me have palpitations.  He told me to just taper off of it...but he wasn't going to rx another muscle relaxer.  Oh...
 
Sorry to make this so long, but I'm really trying to be as brief as I can.  I'm really frustrated.  So that was it with the med issue.  Nothing.  He also said that I most likely have fibromyalgia as well.  After the visit, they asked me to give my urine spec, which I fully expected.  And that was it.  So I will wait on their call and get the injection, which I expected that would be the case.  So here comes the biggie:
 
After I got home, I called my PCP's office to tell the Dr. (who I've had a very good relationship with for about 7 years) about the PM doc taking me off Flexeril and I asked if there was another muscle relaxer I could try, as my lower back and rt leg have been cramping badly.  I was told no, that they all basically had the same side effects...BUT then I was questioned as to why I went to a pain management clinic!  Even though they sent the referral, my PCP said she wasn't aware and asked why didn't I go to an ortho surgeon as she had requested.  She also said that she doesn't normally send her patients to PM and if they did, she would discontinue all pain meds!  Well I fully understand that, but I told her the PM wasn't going to rx pain meds.  Still, she said she would not be refilling my pain meds, which are due in 1 1/2 weeks for refill.  She might consider it with a letter from the PM doc.
 
Now what???  I am so frustrated and the appointment that I thought would help get my life back to a little bit of normalcy, suddenly turned into a big mess!  This just doesn't seem right.  Anyone have any feedback?  Again, I'm so sorry for how long this post is....I didn't know how to make it any shorter and just really feel like crying. sad    Plus I'm hurting really bad...Thanks in advance for your feedback and hope you all are having a low pain day.
DDD, 3 bulging lumbar discs, bone spurs, facet joint arthrosis/sclerosis, osteoarthritis

Jim1969
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Date Joined Jul 2009
Total Posts : 2042
   Posted 8/29/2011 7:23 PM (GMT -6)   
Here is my take on it.

The PM doc doesn't want to Rx meds anyway and if he can "pass the buck" he is going to. He may also be concerned with people seeing more than 1 doctor and getting more than 1 script for pain meds.

Your PCP does not like to Rx pain meds when any of her patients are seeing any other doctor who might also possibly Rx them and until she gets confirmation that the other doc is not and/or will not Rx any meds she wants to bow out. It prob is not personal just her general policy for the same reason the PM doc doesn't want to get into Rx meds if it can be avoided.

What you need to do is call the PM doc's office and ask them to send a letter to your PCP saying that they are not going to be handling your pain meds and also outlining his treatment plan for you. If they mention just making a phone call tell them that won't do it as your PCP wants something in writing. Make sure to have your PCP's full name and address ready to go before making the call.
2 confirmed herniated lumbar discs. Spinal Arthritis. Spinal Stenosis, diabetic peripheral nueropathy.

mrsm123
Veteran Member


Date Joined Dec 2007
Total Posts : 1235
   Posted 8/30/2011 2:32 PM (GMT -6)   
I think that the reason that the PCP ( primary care doctor) is upset is that you didn't see the spine surgeon that she told you to see, but instead saw a pain management doctor . Most GP offices do not know the specialities of the doctors they refer you to, what each doctor does or does not do within the scope of their practices- so they refer you to a spine surgeon, but instead you ask for the referral to your brother's doctor- whom the office thinks is another spine surgeon. Turns out to be a physiatrist/pain management doctor, then you call and tell the GP that this doctor is not going to prescribe your pain medications and took you off flexeril- ask for a new muscle relaxer. She has no way of knowing what if anything this new physiatrist prescribed or didn't, as I am pretty sure she doesn't have the reports as of yet. So she says she is not going to prescribe your meds at this point and questions why you didn't follow through with the spinal surgeon she wanted you to see. This makes you appear to be non compliant.
Sending you to see a spinal surgeon does not necessarily mean that you need surgery, seeing one is to rule out the immediate need for surgery and to figure out a plan of action to help reduce the pain that you are in, sending you to PT , injections, etc....
Sandi
Motorcycle accident 1992, Back problems from 92 to 2005. August 2005- early 2006- Chiropractor care
March 2006- consult with surgeon -PLIF/TLIF L4-5, spondylolysthesis, canal and foraminal stenosis, multiple herniations
Post Op Cauda Equina Syndrome
Revision August 2007- salvage op
March 2011- 2nd onset of Cauda Equina Syndrome
Needs surgery to prevent paralysis

Mysti
Regular Member


Date Joined Jul 2011
Total Posts : 101
   Posted 9/1/2011 4:06 PM (GMT -6)   
I apologize for starting this thread with such a long post...obviously the reason I didn't get much of response.  I was just seeking support from you all as I was so frustrated and not feeling well at all.
 
Thank you, Jim...I think your take is dead-on.  I did call the PM office back and discussed the situation with his nurse.  And his response was "just have your PCP's nurse call me and I will straighten it out.  No problem."  I told him (the nurse) that they probably needed something in writing and he said he would fax a treatment plan if they requested it, but he still wanted to talk to them on the phone first.  We'll see how that turns out.
 
Mrsm, I agree with you...I think my PCP is upset that I chose a PM instead of the orthopedic surgeon she referred me to and it appears I am being non-compliant.  I understand all that.  But as a nurse, myself, I know that it is every patient's right to choose the health care professional they wish, so I knew I was within my rights.  I honestly didn't think my PCP would have a problem with it, but I realize she doesn't know my real reasons for deciding to use my brother's "spinal" doctor.  Incidently, I did call her office to explain all that and ask if she was ok with it....I only spoke with her nurse and was told "that's fine" and she even sent my referral/medical records to the PM doctor.  So I thought it was all settled, when actually the nurse probably never even told her the whole story.
 
Requiem....I suppose you are trying to be helpful, but I find that your referring to "spinal specialists" as "block jocks" is disrespectful and it seems to me that your perception of spinal injections, etc. is a big joke and merely a profit generator.  It is my understanding that you are a physician yourself, unless I missed something somewhere....why do you have such a big chip on your shoulder toward the medical community?  I better stop myself right here....before I become even snarkier than I intend to.  Or I will save my comments for another thread, another time.   
 
I feel like my pain is not being taken serious.  I don't grimace and groan when in the doctor's office, even though I feel like my pain is around a 7 or 8.  I don't know why, but that's just how I am.  The PM doctor even said he thought I probably had fibromyalgia, but then when I asked him if he was going to diagnose me with fibro, he responded with "no, you would probably be in more pain and you don't want another diagnosis."  Well....YES, if he thinks I have it, then DIAGNOSE me, so at least I feel like my pain is validated....and so that all these symptoms I've been feeling could finally have a name.  (I'm not a hypochondriac, but I'm being truthful when I say, I pretty much have EVERY symptom on the list of fibro...)  So once again, I am feeling unvalidated and like my pain isn't anything. 
 
Not a good day today.  I still don't have a date for an injection or anything to help with my pain.  Nor do I have any med changes...except for the elimination of Flexeril.  Maybe I should be looking for a depression forum.... cry
DDD, 3 bulging lumbar discs, bone spurs, facet joint arthrosis/sclerosis, osteoarthritis

mrsm123
Veteran Member


Date Joined Dec 2007
Total Posts : 1235
   Posted 9/1/2011 6:20 PM (GMT -6)   
Mysti,
Not to speak on behalf of Requim, but I think that what he meant by "shot jocks" is that there are those PM doctors who only do injections, when the proof of their effectiveness is not all that great. In fact, I have read multiple studies in which the efficacy of epidural injections is less than 10%. The efficacy also is greater in the first three months, than in later time frames. Those PM doctors who only do injections are properly called interventional pain management doctors, or should be, and it becomes confusing for patients who think they are seeing a pain management doctor who performs the full scope of pain management procedures - to find themselves in an office that only does injections all day, every day but doesn't perform the other available treatments or provide oral pain meds but leaves the GP to do so, when they are well aware that most GP's these days won't even touch chronic pain patients , let alone acute pain.
I hope that the doctor does accept the explanation that you gave the nurse and yes, we certainly do maintain the right to see any doctor that we choose. I do think that your doctor wanted you to consult with the surgeon to see if there is anything on the films that needs to be addressed surgically. When I first had to go down this road, I saw all three types of doctors, a physiatrist first, followed by an immediate appointment with a surgeon and then a referral a few days later to an interventionalist pain management doctor.
I would ask your new physiatrist specifically to evaluate you for fibromyalgia and then ask him to come up with a treatment plan for that.
It may help to separate the appointments since most doctors these days, will only treat one condition at an appointment at a time......
Motorcycle accident 1992, Back problems from 92 to 2005. August 2005- early 2006- Chiropractor care
March 2006- consult with surgeon -PLIF/TLIF L4-5, spondylolysthesis, canal and foraminal stenosis, multiple herniations
Post Op Cauda Equina Syndrome
Revision August 2007- salvage op
March 2011- 2nd onset of Cauda Equina Syndrome
Needs surgery to prevent paralysis

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 16787
   Posted 9/2/2011 1:10 PM (GMT -6)   
Hi Mysti, I just wanted to check to see if you have had any luck getting your dr situation straightened out concerning who is doing what?

I understand what you are saying when you feel like no one is listening to you and taking your pain seriously. Unfortunately, that happens a lot more than we realize a lot of times. When that happens with me then I start doing my homework and try to find a dr that is willing to hear me out and try to help me. I agree just because I don't sit there and moan & groan or be bawling my eyes does not mean I am not in pain either. I get so fed up with the medical profession at times. They forget so oftenif it weren't for sick people or people needing their help they would not have a job.

Sorry, now I am beginning to sound like a rant on your post, lol. Let us know if you get this all taken care and let us know how you are doing.
Moderator Chronic Pain Forum

Mysti
Regular Member


Date Joined Jul 2011
Total Posts : 101
   Posted 9/2/2011 7:56 PM (GMT -6)   
Hi Stray, good to hear from you.  Well, my PCP's nurse called me today and said that she received a letter from my PM re: my treatment plan and she said they noted that they would NOT be handling my pain meds.  So the nurse has placed this on my chart at my PCP's office...so that's good.  I suppose I will continue to get refills from her.  But I have some questions about that.
 
From time to time I will likely have pain issues that I will need to call the dr. for.  It seems to me, that by having a "pain doctor", I would call him in such an event.  However, it looks like I will be calling my primary doc since she is the one rx'ing the meds.  It's pretty obvious she isn't comfortable increasing my meds (3 vics per day max), so I don't see what use it is to call her.  And I can't call the pain doc...who isn't scripting my meds.  He could...and he could give me stronger meds, but since I have a PCP already rx'ing pain meds, he is leaving that alone.
 
Seems like a mess to me.  My PCP won't know what's going on with the pain mgmnt stuff...I don't know...I just don't like the way they have set this up.  I really thought the "pain doc" would rx my pain meds.
 
And by the way, my first visit with him was last Monday.  They were supposed to call me back to get me scheduled for a epidural injection.  I haven't heard a word from them.  It's just as well.  Now my neck is hurting worse than my low back and leg.  Go figure.  It's like the pain just moves around on a daily basis.  So injecting one area isn't going to "fix" me, as my family seems to think it will.  But that's another story...
 
Thanks y'all for your input, and I hope you are having a low pain day.
 
(((((HUGS))))))
DDD, 3 bulging lumbar discs, bone spurs, facet joint arthrosis/sclerosis, osteoarthritis

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 16787
   Posted 9/3/2011 2:15 AM (GMT -6)   
Mysti, I don't blame you a bit for how this whole thing has played out. I know you put a lot into this PM dr, but if this were me, I would be looking for a new one and one that will be taking over my care totally. It is never good to be yoyoed back & forth between drs when one dr could handle it all, plus it will cost you more in co-pays with two involved. Many PCP's do have a cap on what they will rx to a patient, my gastro is this way. He will only script to a certain pain medication, anything beyond that its either back to your PCP or go to PM.

The only other thing I can think of is, the next time you see him make it very clear that you were under the impression he would taking care of you, including writing out your scripts for meds and that is your preference instead of being sent back & forth between two drs. Or, if you have already told him this, then I guess it would do no good to say it all again.

A part of me sort of thinks he could be a PM dr that really would rather do injections and procedures on his patients and limit himself on writing scripts for meds. There are some that do nothing but injections and procedures and no scripts at all.

Let us know what you decide to do. Take care.
Moderator Chronic Pain Forum

Screaming Eagle
Veteran Member


Date Joined Sep 2009
Total Posts : 5005
   Posted 9/3/2011 8:23 AM (GMT -6)   
 
     Morning Mysti!
 
         WOW, sounds like a mess, and I don't blame you one bit for being frustrated with it all. shakehead
 
    I have to agree with Stray here, and wonder if maybe when you see your PCD again ask that if she is not willing to script med's much higher than what you are on....if she would be willing to suggest a PM that does.
 
     My PCD was kind of like this for a while, but after he realized that the PM's in this area were getting cold feet, and the patients were suffering for it, he loosened his limit, and started working with me to find a script that would better manage my pain.
 
     Keep working on it, and hang in there. I know it can be discouraging. It shouldn't be this way, but sadly it seem to be.
 
         Take care, and also please do update us. Like I have said before...we do care!
 
       SE wink
Moderator Chronic Pain Forum

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Mysti
Regular Member


Date Joined Jul 2011
Total Posts : 101
   Posted 9/3/2011 1:31 PM (GMT -6)   
Thank yall so much for your replies and support.  I'm having a really bad day today, as far as my pain goes.  My back is really hurting and I am walking hunched over...it hurts to move.  I feel ashamed to even complain because I can see there are so many more folks in far worse condition than me on this forum.
 
Yes, it does appear that this PM doc is just one that does injections only, but the thing is, when I first called them to make appointment, I asked them that question.  I specifically asked "does he write rx's?  Will he take over scripting my pain meds?"  and I was told "yes, he will."  The paperwork I signed even discussed the fact that this clinic often used long-acting opiates and explained the pain contract, which I signed.  It also said to bring all my meds in with me, as they will be counted.  I guess that's the reason for my disappointment here.  When I was visiting with the doctor, last Monday, at my appt, he told me that since I already had a primary doc rx'ing my pain meds, he will not be doing it.  He said "the primary doctors like to feel they are kept in the loop, so it's best to just let them keep prescribing the meds..."  So I guess that's it.  I understand that rationale to a point.  They didn't check my meds during the appt, but they did ask for a urine spec, which I know was good, because I've been taking my meds as prescribed and certainly nothing else. 
 
I wasn't even told how often I would need to see the PM doc.  It was just a "we'll call you when your injection will be scheduled", which I never heard back from them.
 
I can't look for another doctor.  My PCP is already unhappy with me for going outside her own referral of an ortho surgeon...so she has sent referrals and my records twice to 2 different docs now....I don't see any way that asking her to do that a 3rd time would be conceivable.  I think it would really appear I was doctor shopping if I did that.  So I feel stuck.  I guess I screwed up by not going to her preferred doc, but my friend had told me that he totally messed up her knee and put the wrong size knee replacement in, which resulted in her having to go to another surgeon to have it redone.  So I just chose to go to the doctor that my brother goes to for his back...this "pain management" doctor I just saw.  Thanks bro.
 
Ok, I need to stop whining and be thankful I'm not in worse shape. 
DDD, 3 bulging lumbar discs, bone spurs, facet joint arthrosis/sclerosis, osteoarthritis

mrsm123
Veteran Member


Date Joined Dec 2007
Total Posts : 1235
   Posted 9/3/2011 2:46 PM (GMT -6)   
Mysti,
Ask the office manager to fax your records to any new PM doctor that you may find. That elimates the GP from being upset about it.
It may be that since this PM doctor is setting up injections for you, that they will then give you a new appointment after the first injection is done. And you may find that they will prescribe your medications once your initial urine screen comes back "clean" for any other substances. Most PM's these days will not write prescriptions for a new patient until their first urine screen comes back, since that avoids the potential, at least in part for new patients who show up just for prescriptions that they may not need. And if they do have you come in after the first injection, that gives the doctor an idea about how well the injection may or may not have worked for you, and where to go on the treatment spectrum from there. Don't loose hope just yet. It may still all work out in the end.
PM doctors that do both interventional pain management and do write prescriptions want to see compliance from a new patient- in other words that the patient follows the direction and suggestions of the doctor before going into prescribing opiates or any other substance for them. It's them following the standard of care for the condition they are treating the patient for. It can be frustrating for a new patient who needs pain medications but there is a treatment protocol that they follow when treating and it can take a bit of time for the doctor to figure out what is going to work or not work for each patient.
Next time you see this doctor, talk to him about your GP not being willing to prescribe anything other than what you are currently taking, how it is working or not working at times for you and ask for his recommendations and ask him specifically if he is willing to take over your prescribing and go from there.
I'm sorry that you are feeling badly. I hope things improve alot.
Sandi
Motorcycle accident 1992, Back problems from 92 to 2005. August 2005- early 2006- Chiropractor care
March 2006- consult with surgeon -PLIF/TLIF L4-5, spondylolysthesis, canal and foraminal stenosis, multiple herniations
Post Op Cauda Equina Syndrome
Revision August 2007- salvage op
March 2011- 2nd onset of Cauda Equina Syndrome
Needs surgery to prevent paralysis
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