Re: My experience with pain and sleep last night, plus a brief update RE me getting into the pain clinic

[Guest guest]

If this pain clinic doesn't give pain meds you are going to be terribly

disappointed as most all pcp's do not prescribe pain medication that is going to

relieve chronic pain.

I know you are hoping but I think you need to get into a pain clinic that does

prescribe pain meds. They exist. I go to one in Muncie.

Jennette

wrote:

Also if I am accepted to this pain clinic, then I am going to ask my

neurologist if he would be willing to prescribe for me enough pain medicine to

get me through until I see the pain doctor, assuming that the pain doctor will

prescribe pain meds. I am skeptical because their website says that they don't,

but rather that patients have to go through their PCPs or the doctors who

referred them in order to get prescriptions for medicine.

[Guest guest]

Jennette wrote:

> If this pain clinic doesn't give pain meds you are going to be terribly

> disappointed as most all pcp's do not prescribe pain medication that is going

to

> relieve chronic pain.

>

> I know you are hoping but I think you need to get into a pain clinic that does

prescribe pain meds. They exist. I go to one in Muncie.Jenette,

I agree and getting into a pain clinic that is supportive is important. When I

was waiting for my records to be reviewed when I switched to a pain clinic

closer to home, my current pain management doctor prescribed my medication and

when I have been in a bind and away from home, my gp prescribed my pain

medications until I got in.

Hospitals have a physican referral listing of doctors and their speciality which

is a contact, along with pain societies and other websites have pain management

doctors (American Pain Foundation is one) that has listings of pain management

doctors.

Asking a potential pain management clinic if they prescribe medication

management is appropriate and when I write about pain dairies this is one

situation I found them to be life savers.

Bringing my pain dairy and functional assessment to a new pain managment doctor

showed them my pain levels, what I have been prescribed, what has worked and

what has not. I always included the physical therapy, stretches, heat, and other

modes of treatment I tried.

Being prepared of what you need and accept of a new doctor is appropriate and

lets them know you . These are the things that worked for me and staying in pain

without relief and keeping the same doctors is only going to make pain worse and

create a sense of helplessness and cause more stress which causes more pain.

Bennie,

>

> Jennette

>

>

>

>

[Guest guest]

I go to an " Interventional Pain Management " place that only deals

with things like implants, injections, etc. BUT, my GP has always prescribed

for me and we're all comfortable with that arrangement.

So there ARE GPs who will prescribe, you just have to find them.

Marta

[Guest guest]

Most pcp's and GP's do not want to be scrutinized by the FDA so they don't

prescribe the extended release forms of narcotic/opiate pain medications.

Pain Clinics abide by the rules set forth by the FDA and pass this along to us

via pain contracts.

Chronic pain is best treated with extended release pain medications instead of

the short acting meds like vicoden and percocet.

In the USA this is the course pain treatment has taken.

Marta, what pain medication is your GP prescribing?

Jennette

> Marta wrote:

> I go to an " Interventional Pain Management " place that only deals

with things like implants, injections, etc. BUT, my GP has always prescribed

for me and we're all comfortable with that arrangement.

[Guest guest]

I just spoke with the referral clerk at the pain clinic. She told me that I got

accepted as a patient (YAY!!!), and so she scheduled me with a dr's first

available appointment--which, unfortunately, is not until July 6th.

I also asked her about the drs there prescribing pain medicine, and she told me

that it is an " interventional " pain clinic (like Marta's). She said that this

means that they do not prescribe pain medicine, they just do things like

injections, pain pumps, spinal cord stimulators, etc. BUT, there is GOOD NEWS:

The lady I spoke with said that they DO refer patients to a doctor who DOES

prescribe pain medicine--and they that it is " common " for them to make such

referrals. So, YAY!!! again!!!

I think that I will be okay...IF I can get my regular neurologist (Dr. to

prescribe some pain medicine in the mean time, while I wait for my appointment

with the pain clinic. I have an appt with Dr. B on June 22nd, but I am about to

call their office to see if I can get in earlier because I will definitely run

out of my pain medicine (which an ER doctor prescribed for migraines) before

then. I will update you once I talk to their office.

Thank you all for the wonderful and supportive responses!!!

e.h.

> Jennette wrote:

> I know you are hoping but I think you need to get into a pain clinic that does

prescribe pain meds. They exist. I go to one in Muncie.

[Guest guest]

> Marta wrote:

> I go to an " Interventional Pain Management " place that only deals

> with things like implants, injections, etc. BUT, my GP has always prescribed

for me and we're all comfortable with that arrangement.

>

> So there ARE GPs who will prescribe, you just have to find them.

Marta,

You have a good GP, then. I go to a comprehensive pain management group that

deals with all of the situations and refers to a neurosurgeon to do the trials

and implants and then is referred back to pain management doctor. They have a

team that reviews you case that includes a therapist, rehab specialist, the pain

management doctor that does the injections, and the nurse manager. They believe

in alternative modes to include acuputure, water therapy, physical therapy,

biofeedback, and other modes of assistance.

I found this to be good and I was on a maintenance plan, so to speak, so my

medication management I have with my home physical therapy program was approved

and I spoke to the therapist and he said I would not have to come each time

since I had accepted my limitations and had a program in place but he was there

if he was needed and he would just like me to call in every four to six months

otherwise. This works well for me as I do not have to drive around to get

services. Bennie

[Guest guest]

What a relief to know you can get the help you need. It took me 3 months to get

into my pain doctor, but it's been well worth the wait.

I'm glad for you.

Jennette

> E. H. wrote:

> I just spoke with the referral clerk at the pain clinic. She told me that I

got accepted as a patient (YAY!!!), and so she scheduled me with a dr's first

available appointment--which, unfortunately, is not until July 6th.

[Guest guest]

> wrote:

> I also asked her about the drs there prescribing pain medicine, and she told

me that it is an " interventional " pain clinic (like Marta's). She said that this

means that they do not prescribe pain medicine, they just do things like

injections, pain pumps, spinal cord stimulators, etc. BUT, there is GOOD NEWS:

The lady I spoke with said that they DO refer patients to a doctor who DOES

prescribe pain medicine--and they that it is " common " for them to make such

referrals. So, YAY!!! again!!!

,

If it were me, now not telling you what to do here : ) I would ask the clerk if

you could go ahead and get some of the pain doctors name that do prescribe

medications so that you could get an appointment with them for evaluation. This

way it does not seem like you are drug seeking as you are asking for an

evaluation and then you do not have to wait forever if you have a referral from

the interventional doctors and then have to wait for an appointment with the

interventional doctor. I have done this with appointments I needed in the past

so that I had all my bases covered.

This comes with my experience of having to " wait on doctors appointments " and be

at the mercy of them. Usually the pain management doctor who prescribes your

medication refers you to an interventional pain management clinic because the

medications no longer work and they want to try another approach.

There is a hierarchy, so to speak, a ladder of pain management treatment and it

is that a patient is treated with non narcotics, then narcotics that are not

class 2 (Ultram, Darvocet) , then the opoids ( Lortabs, oxycodone, hydrocodone)

then stronger (Morphines, Fentyls) , injections (trigger points, epidurals and

other injections ) then invasive procedures that include the pain pump,

neurostimulator, and surgery. It can be researched on the internet as pain

ladder and is devised by WHO (World Health Organization)

As with all doctors, they are going to tell you their procedures are the best

(usual practice) Neurosurgeons will tell you that surgery is a best alternative,

anesthesiologists that believe in injections will tell you injections are

necessary and even though they prescribe opioids, will insist on injections as

part of their treatment, and interventional pain management doctors will tell

you that the procedures they offer are the best.

The dosage of Loratabs you have taken is very small and usually a

doctor will titer (increase) the dosage to an acceptable amount to provide you

comfort and if this does not work, they go to a timed dosage that offers you

medication 24 hours (I take a 24 hour release Morphine now trying to avoid

neurotransmitters as I scar easily and already have instrumentation) and then if

that does not work, they offer the invasive procedures.

It seems you have the cart before the horse so to speak and hope for you the

processes that are usually accepted pain management procedures.

I share these experiences in the hope that it prevents you a delay in getting

the care needed for you. So, hope this works for you and you can also get in

for an evaluation from a pain management doctor that prescribes medication

appropriately for you care. I share these experiences because I sincerely hope

you get on a program that assist you soon to get you out of pain. If you do not

know of options, like I did not as I stumbled through the process, you can be

confused about how it works as I am still learning I can say " No " to any

procedure offered to me.

I spoke to my gp when I first started my pain journey and she referred me to a

pain management group who evaluated me for medication management . Maybe if you

speak with you gp, he can get you into a pain management doctor who will

evaluate you for medication management also. Good Luck. Bennie

[Guest guest]

My PCP (I believe PCP & GP are the same, just US & UK terms, respectively) has

prescribed for me for years. Lately, he has made me see a pain specialist 1.5

hours away (Reminder: I have CFS, brain tumor, Fibromyalgia & possible RSD) who

I have to convince to make recommendations every time I need a dose change. I

have never been on an adequate dose.

-Steve M in PA

Duragesic 250mcg/hr (change patch every 48 hours)

OxyIR 30mg six per day (prescribed as prn, but I need maximum dose every day)

Actiq 600mcg four per day (prescribed as prn, but I always need maximum dose)

> Marta wrote:

> So there ARE GPs who will prescribe, you just have to find them.

[Guest guest]

I've never had a problem with my PCPs giving me my med scripts. It really

depends on the doctor if they will write the script or not. BUT, many who work

with non-prescribing pain clinics DO give the scripts out.

Marta

> Jennette wrote:

> In the USA this is the course pain treatment has taken.

> Marta, what pain medication is your GP prescribing?

[Guest guest]

Bennie,

Okay, that sounds like it makes much more sense--i.e., to try oral pain meds

BEFORE all the other procedures. The only thing I was confused about is

injections: I didn't know if they were " at the bottom of the pain management

ladder " or " midway up the latter " , in terms of their relation to oral pain

meds on the ladder. If oral pain meds are at the bottom of the ladder (right

above the Ultram and Darvocet, of course--both of which I've tried and

neither of which work), then I DO want to go to see the doctor who

prescribes meds (he is actually a neurologist).

I will definitely call their office back first chance I have on Tuesday

(Monday being the Memorial Day holiday) and ask to be referred to the

neurologist (I do know his last name, butt for privacy purposes on the list,

I will call him Dr. S--unless I forget and spell out his name by mistake).

I definitely, DEFINITELY want to start at the BOTTOM of the pain ladder and

go UP, not at the MIDDLE of the ladder and then have to work my way DOWN

once I found out that I was getting unnecessary treatments (i.e., they would

be the injections).

I should mention that the lady I spoke with (who scheduled me with the

doctor who does NOT prescribe meds) was the referral clerk, not a doctor

(although I think she mentioned that she was a nurse, but I could be

mistaken). It is possible that she does not know of the pain ladder, and

that the doctor who she scheduled me with for a consultation does. She said

that the doctor I would meet with and I, together, could and would decide

which was the better course of action at this time: oral pain meds (opioids

in this case) or injections. I will call her (the referral clerk) back and

ask to be referred to Dr. S so that I can move up the ladder at the correct

pace.

Thank you so much, Bennie, for making me aware of this (the pain ladder).

Without this information, I would otherwise have waited until July 6th to

see the interventional doctor, and then if he did refer me to the Dr. S

(there is the possibility that he would not), then I would have to wait

ANOTHER 4-6 weeks to get in. This way, I can get in to see Dr. S much

sooner.

Let's hope that, in the mean time, Dr. B (my regular neurologist) will be

willing to prescribe Lortabs (or something) so that my pain can be at least

a little bit under control in the mean time, before I get in to see Dr. S. I

would really like to be able to sleep at night, and if I don't take a half

of a Lortab before I go to bed (i.e., if I just take aspirin or something

OTC), then I cannot sleep.

Thank you!!

e.h.

>Bennie wrote:

>

> ,

>

> If it were me, now not telling you what to do here : )

> There is a hierarchy, so to speak, a ladder of pain management treatment.

[Guest guest]

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Hi  Jennette

In  May  you wrote that  you  went  to a pain clinic in  Muncie. Is that

in Muncie P.A.?

I  ask  because  i  have  kids  that  live near Muncie P.A. and have need  of 

clinic  that  gives pain  meds. They  are in port and  cant  find  help

for  pain  meds. Thanks 

Viv in  Connecticut