Posted 4/3/2012 4:14 PM (GMT -7)
I've been to two PM doctors and the initial appointments were quite similar.
Both had me strip down to underwear and wear a hospital gown. I'm not sure why and I suspect that they were looking for signs of drug use, i.e. track marks. I could chalk it up to thoroughness, but they didn't conduct any other examination or tests (other than Urine).
They both had their PA's take histories: duration in pain, diagnoses, surgeries, procedures, meds used, etc..
Then both indicated that they require their patients take an ER medication. The first PM started me on 200mg of Ultram and the next PM moved me up to 300mg. If I recall correctly, the first PM wrote be a script for hydrocodone as well, but I'm not sure if my memory is correct. The other PM wrote me a script for dilaudid, just 15 or so pills to try and scheduled an appointment 2 weeks hence.
With the second PM, one issue we were dealing with was that I couldn't sleep after taking any opioids, so in the succeeding months, he wrote me scripts for just about every IR out there. So, if you have negative side effects from some, of course mention it; and if you've found that others help a lot, it will likely be a good idea to mention that too.
I realize that there is a risk that by mentioning a specific med, a doctor may think you're just out to get it. But if the PM is any good and accepts that you have real CP, there should be no problem bringing up what has helped. Further, since it is Nucynta, vs. say, Oxycodone, you should be fine. It doesn't have the same abuse profile as some of the more common opioids.
As for meds and procedure -- that may depend a lot on the details. But one issue is that they may not want to start you on anything new at the same time as an epidural since they will want to see if the latter helps.
C4-T4 Scoliosis (disk degeneration, stenosis, narrowed neuroforamen, bone spurs), RT hip and SI joint damage from car accident. Also, pectus excavatum, supraventricular tacycardia and mitral valve prolapse syndrome.
Current meds: Ultram ER 300mg & 2-3x 10mg Hydrocodone daily. Oxycodone 10mg for BT. .25-.5mg xanax as needed for sleep, Verapamil 240mg SR (for tachycardia). [/gray