Re: Establishing a Pain Treatment plan- h.e.

[Guest guest]

e h

> 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

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Not to overload you with information but the most informative guide I found to

pain management was referred by my original pain management Doctor (who started

a pain foundation with Dr. Tenent) is written by Dr. Forest Tenent called " The

Intractable Pain Patient's Handbook for Survival " .

This guide opened my eyes to what I needed to do to have comprehensive pain plan

and how to get a pain management specialist to treat my pain condition and the

non invasive procedures to start with and then the alternatives, invasive

procedures, if and when non invasive procedures do not work.

In the Guide, Dr. Tenent writes: " There are two cardinal rules. Do not attempt

an intervention that causes pain. Simply stop in the mid- dle of the procedure

if necessary. The second is don't stop your medication to try a procedure or

intervention. Only an ignorant or biased practitioner will even suggest you stop

your medication to have surgery or an intervention. Turn and run from any

practitioner who may suggest this. "

The Intractable Pain Patient's Handbook for Survival by Dr. Forest Tenent also

has an inventory list of pain triggers and pain medications you can rotate and

should when on medication therapy. This is to prevent tolerance (each person has

their own time line and this should be co ordinated with your Doctor and he

should be titering you to a level that gets you pain relief) . This is what most

competent pain management Doctors do.

I have found this handbook one of the best as it deals with the importance of

nutrition, exercise (if only stretches), other medications/supplements to

enhance pain relief(hormones, Vitamin D. DHEA and others ),therapy, a chapter on

family and the effect on pain to them, advocacy groups and their importance,and

other things that help with pain relief. It not only list the things you can do

to get pain relief but explains why.

He deals with the treatment of pain from many years of experience and research

and co authors a Pain Journal accepted by the medical community. You can

download this guide and even take it to your GP, as many patients do, and my

pain management Doctor thanked me for giving her a copy. You can do this with an

internet search with the title or it is listed on a website called

paintopics.org which is also a good website.

Usually in all medication treatments you start with the non invasive and then

the last course, invasive procedures. I just thought that you might prevent a

delay by getting a pain management doctor that treats with non invasive

treatments first, then will refer you to invasive, if and when you need them.

If you have a pain management doctor who is an anesthesiologist, they mostly

will suggest injections with and instead of medication, depending on their

philosophy.

Some do the injections along with medication therapy. Protocol from the

American Spine Society, suggest on three epidural injections to the patient

because if that does not work, then it is apparent it is not a viable option for

pain relief. (ref: Spine Universe website).

Unfortunately, someone forgot to tell one of my previous pain management doctors

that and I became a pin cushion with epidural injections, faucet injections,

sacral iliac injections, diagnostic injections (just sticking to find the place

the pain might be generated from), and trigger point injections, and he made

thousands of dollars each injection and I can see where that would be a

lucrative practice rather than just getting paid a doctors office fee to

recommend medication.

Well, after all those procedures, times three in a row,(which was over

twenty-five injections), the doctor did a disco gram with thin cut CT levels

(which he should have done this after the first three epidurals didn't work. The

American Society recommends disco grams be done when a pain trigger cannot be

determined). The disco gram showed I had three lumber vertebrae that were

virtually gone because of fissures and they were shriveled up and disinergrated.

Because of my experience and not knowing you can get arachnoiditis (which I now

have) from repeated spinal injections because the medication they inject are

neuro toxins, I did not refuse them because I wanted pain relief. At the time,

I was in so much pain I trusted my doctor and did not research or get second

opinions on spinal injections. This doctors protocol was that if you are

prescribed pain medications, you also must submit to spinal injections or he

would not treat you.

After the disco gram, he came in the room with a reddened, embarrassed look. He

told me I had a poor prognosis and that he was sorry that he did not believe I

was in pain. He used to argue that Ultram should take care of my back pain and

it did not. This Doctor chastised me and told me I missed appointments and I

told him that the two appointments " I missed " were the time my Mother died and I

called the nurse and told her and the time I was on an active duty tour.

I was so mad, I got a copy of my Mother's death certificate and my military

orders and wrote a letter to him, dismissing him, and asking him to put the memo

I wrote explaining my missed appointment and my coordination with his Nurse who

approved my husband picking up my prescriptions and sending them to me.

I did this as I did not want to be black balled and not able to get another pain

management doctor if he put in the doctors notes that I was non complaint.

I have seen Doctors do this and ruin patients chances of being accepted by

another Doctor.

After that experience, I now interview my doctors for " my protocol " and that I

have the right to say " NO " to any procedures I do not want.

Most pain doctors have a pain contract and the conditions you must meet and

agree to.

I have found that there is more emphasize placed on the doctors section and

attention needs to be paid that there is also a section of what they are

supposed to do, called the patient's rights and Doctor's responsibility.(Like

return calls within 24 hours, advise you of side effects of any procedures they

suggest)

I have had several Doctors that do not do address patients rights. After three

years of my last pain management doctor that was in a group and had his own

surgical centers and was recruiting all the single pain practitioners into his

group, I left. It was becoming a franchise rather than a Doctor's office. I

expected to see a Mc 's to be opened inside his Doctor's megaplex : )

The care I received was only by a Nurse Practitioner that made me pee in a cup

monthly to make sure I was not a drug addict, and lecture me if I was short

medication (which only happened two times when I had a virus and puked up my

medications and called them and told them and they couldn't get me in but I had

a note from my GP who gave me anti nausea medication, and when I tested positive

for another pain medication they did not prescribe as I had just come out of the

hospital and they had given me Diladaud and it showed up).

Every pain patient has the right to be treated respectfully and their pain

validated. There are laws to protect Pain Patients and each state has them but

we rarely hear that side of the story. I was not being treated like a patient

but rather like a number that was called and billed for payment.

Well, , I didn't mean to write a book and am glad my experience helped

you . I wish that no one ever has some of the rudeness I have encountered but I

know some members have. It is nice to be able to come here and be able to be

encouraged that you can find adequate pain relief and members assist you by

their experiences.

I am so thankful for the members here who have encouraged me , I have had the

opportunity to learn from their experiences especially about the good results

that pain pumps and nuerostimulators have offered some members here.

These are two options my neurosurgeon has suggested to me as I have a fragment

of herniated disc that might impinge nerves and causes further pain. It has

showed up on my MRI's and CT's and we are monitoring that and as long as it does

not block anything or impinge a nerve, I am depending on medication therapy.

I hope that you get an appointment for a pain management doctor that will take

you through you options and also talk to about a rheumotologist, if needed, for

you osteoarthritis. I have specialists I see along with my pain management

doctor and they coordinate my care together.

Let us know what you find out and hope for you good pain relief for you spinal

problems, headaches, and osteoarthritis.

Bennie

*I take Benadryl for sleep, in the old days (ha, I am old old nurse) they used

to prescribe Benadryl for sleep and nausea) and it works for me, but check with

your doctor first.