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Thoughts on Pain Management Clinic?
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jessdes posted:
Today was my first time going to a pain management clinic, and it did not go so well, so I was wondering what others opinion was of these types of places. I didnt want to let myself get too discouraged by this. The clinic I went to today was in my local hospital.

I am 27 yrs old and have chronic lower back pain. Recently, it was discovered that I was born with a tilted pelvis, which caused the left joint that connects my spine to my pelvis (think its the sacroylliac joint?) to be improperly formed. This caused the same joint on the right side to overcompensate for the lack of the left joint, and now the joint is severely worn. Sorry for the lack of medical terminology - im still not 100% understanding of my diagnosis because it was very recently that my doctors figured it out.

Currently, my medications are Etodolac 2x day and Percocet 5/325 1-2 pills 2-3 times a day, depending on how bad the pain is. My work consists of sitting for long periods of time in meetings or on the computer, and sitting is one of the biggest triggers of pain for me. Laying on my back or side also causes me a lot of pain, so I have to sleep lying on my stomach with a pillow under my stomach.

I left my appointment today feeling very discouraged and fustrated. I took my medications as usual today, so I had taken the Etodolac and Percocet about 2.5 hours before my appointment - no one told me otherwise. When the doctor saw me, he was surprised that I wasnt in a lot of pain - I would say a 4/10 opposed to a 9/10 when I am not taking any medication. I would like to think that ive began to tolerate the pain more now than i used to, simply from being used to it, so a 4/10 isnt as bad as it used to be for me - its pretty tolerable. I told him that I had taken my medications, and they work pretty well for me, so im not im much pain. He suggested that maybe I come back another time and plan to go without medication for the day and make a later appointment so the pain is at its worse. I was surpsied that no one suggested that when the appointment was made, or that the doctor isnt used to seeing patients that are currently taking medications.

The second thing was the doctor I saw (im guessing thats what he was) seemed to disagree with my diagnosis, but didnt have an alternate explanation for what he thought the cause of my pain could be. He claimed to have reviewed my MRI report and x-rays, but he also commented when I arrived that I was early (whoops - 10 min) and it took him quite some time to come in to see me, so who knows if he was doing a quick reivew at the time. The radiologist that read the xray works at the same hopsital, and my primary care had a few conversations with the radiologist regarding his findings so that he could fully understand the diagnosis. I thought it was somewhat lazy that the doctor at the clinic didnt think to consult with the radiologist to see why they came to different conclusions.

In the end, I left with an appointment for next week where I need to arrive in pain, and I had no answers to what my next steps are or if I could benefit from any cortisone injections as my primary care had sent me there for.

Has anyone else had similar experiences with pain clinics? Are they really capable to giving a proper diagnosis, or are they there to treat the diagnosis you came to see them with?
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butterfly_gurl responded:
Sorry you had to go through that. I'm no kind of doctor & this is just my opinion. I've been in the same situation as you as in doctors making me feel discouraged & frustrated. I went through that for 5yrs or so until I found the right doc. for me & one who understood me, took the time to talk w/ me & explains things to me. To me it sounds like the doc. you went to go see is an A*S. I don't see why you had to see him while you were in pain. I've never been told to do that by any doc. I've seen. Maybe he wanted to do an examine to see how far you can bend, tilt,sit,crop,scoop,ETC...... until it started hurting while you were in pain. I really don't know. But I don't see why he couldn't talk to you about your condition & what he thought & explain his reasons for not agreeing with the other doctors. Are you wanting to stay with this doc. to see what he has to say??? Can you go see another doc. at another Pain Management Clinic?? If you go to your app. next week & you don't like how he treats you, & doesn't explain things to you to where you understand them, or just acts like your a waste of his time, I would go to another doc. until you find the right one for you. Remember this is just my opinion. Sorry I couldn't help more. Take care & best wishes.
 
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annette030 responded:
All the radiologist does is write a report based on what he sees on the films, he does not really make a diagnosis. Your pcp would have done that after checking out the xray/MRI and examining you and taking a medical history.

I agree with Cheree that the doctor at the pain management clinic may have wanted to examine you unmedicated so he could see how far you could move until the pain would make you stop. That is really the best way for him to tell where to inject you to fix your pain. If you aren't in pain when you see him how can he figure out the best place to put the injection that your pcp sent you there in hopes of getting. When I worked in the ER, surgeons hated it if we medicated patients with abdominal pain before they examined them, it really hinders making a good exam if the patient has had too much medicine.

His main job is not to make a diagnosis, but to treat your pain so you can best function in life. If I wanted to be certain of a diagnosis with back pain, I would go from my pcp to a neurologist or orthopedic doctor who specializes in the spine.

Take care, Annette
 
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MegElaine8 responded:
My name is Megan. I have Fibromyalgia. I amnot really familiar with your condition, but I am familiar with the fustration with doctors. It took 15 doctors to diagnose me after my car accident Christmas Eve '05. Because there was no physical evidence, I was told that the pain was in my head, that the pain was triggered by anxiety. Now, yes I was also diagnosed with Post Truamatic Stress from the accident but I am a social worker and have worked with many people with anxiety. I believe with all of my heart that if you cannot get out of bed for days on end or you just wish God would take you from this earth (not that I would ever hurt myself), that is more than anxiety. I went to doctors that have invented procedures, written books, claimed that if they couldn't find the problem that they had a team approach (I never had any of these doctors even consult their "team"). I would leave every appt with no answers, rarely any suggestions, and in tears. I am only 27 years old and was being told that there was nothing anyone could do (although a few tried medications which helped some, and trigger point injections which made me worse), I would have to live with it the rest of my life, and there was nothing wrong with me. My point: Don't give up. Be stubborn. Know that there is too much wonderful technology out there for a doctor to say "nothing can be done". Keep seeing different doctors, carry all of your films with you to each doctor, ask if you can go over (or say "Can you Explain my films to me") your films together (this will help ensure that the doc really does look at them). Keep trying different medication and dosages. It took me a really long time to find the right combo. If you end up on Narcotics I highly suggest Methadone. When I was Oxycotin, my memory was horrible and if I missed a dose or two I had horrible withdrawals. Methadone however is made where there are very little, if any withdrawals. That is why they use it for people that are trying to quit heroine. There are medications a lot stronger that what you have out there. Some doctors are scared to prescribe controlled substances, but it helped me a ton. I have had an Electrical Cord Stimulator put in and although it isn't a magic wand, I am am able to do things that would normally put me in bed for days. It is a cross between a TENS Unit (that uses electricity and the tingling feeling beats the pain feeling to the brain and so it tricks it into feeling this tingling, massaging feeling) and a pain pump (in that it is implanted and I can turn it up when in more pain, down when in less). I do not know if this is an option for you. I also have learned that doing things like sitting with a lumbar pillow behind my back when I have to sit for long periods of time (especially at the computer and in the car). At the computer be careful and streatch often because your back and shoulders tend to tighten and hunch over. I think it is 5x your weight you are putting on your back when you sit. Something like that. I sleep with a heating pad that velcros around me, so as I turn over or sleep on my side it stays with me. I also sleep with a body pillow that I can roll over onto and be at a angle between laying on my side and my stomach and I throw one leg over the pillow. Exercise and building up your strength is so important, I have lost so much strength over the years that little things are hard. Do everything in moderation otherwise you are doing more damage then good. I have also found that soaking my msucles in a bath with Lavander bath salt has helped quite a bit. It took me from 12/25/05 until this past March to get this far (and I also lost my job and had to move back in with my parents), but I am building up strength and backing off the medication. I have also been able to return to doing some work. I HAVE LEARNED DURING THIS TIME THAT BEING STUBBORN IS NOT ALWAYS A BAD THING. REFUSE TO LIVE IN THE CONDITION YOU CURRENTLY ARE IN AND NEVER GIVE UP. My best wishes to you
 
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MegElaine8 responded:
Sorry I forgot. I wanted to say that it is always best to go into the doctor in pain (which really sucks for you, but helps in the long run). This allows the doctor to get a really sense of where your pain is, where it hurts the most, and by watching your body language he can tell how bad the pain really is. Like with Fibromyalgia, you are supposed to have like 13 (?) tender points. If I am having a good day and took my medication, than I might not have recieved the diagnoses because I didn't have those tender points at that time. I have also tried to show a doctor exactly where it hurt, but then got a spasm and realized that I was off maybe an inch or two. I try to make my appts for the morning so I do not have to go all day without meds. Unless it was a horrible day where I was not going to be able to walk, I would try not to do things like take a hot bath or other things that would help, just to give the doctor a more realistic picture. Also I have had doctors that have been leery about upping my dosage on a controlled substance. I knew I needed more, but if I go in with no pain that day, he is not going to see the need to up my dosage, especially when there are so many rules around controlled substances and doctors are always afraid of loosing their licsense over something like that. Again, I am so sorry you have to go through the pain, but keep fighting!!
 
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mbingaman responded:
I am sorry that you are having to go through this but I have been a patient at a pain clinic since 1994 & they have saved my life. I was at the end of my rope from the pain & was seriously contemplating suicide because the doctors were acting like all I wanted was the pain meds, when all I wanted was for the pain to ease up. The 1st doctor I saw was very straightforward with the fact that we could try the steriod injections, in my back, but he didn't really know if they were going to help or not because I had "failed back syndrome" from back surgery in 1/1992 when they repaired a ruptured disk. It had ruptured into my siatic nerve & they went in & picked out the pieced of the disk from the nerve & as a result, I developed scar tissue around the L5, S1 nerve bundle & its so close to the spinal cord there is nothing they can do to remove it. Then on my 3rd visit to the pain clinic, I was turned over to another doctor because the 1st doctor was going back to doing just anesthesia & I still see him to this day, even though he has moved to a clinic about 45 miles away but I make that drive every month. I had the seriod injections in sets of 3, 1 every 2 weeks, about 6 months apart for about 6 years & then they started not working as well & I needed more pain meds. He tried freezing the facet joints but that didn't work; we looked at implanting a pain medicine pump, but I was not thrilled with that idea because it required surgery. He finally started a medication program which I have been on since 1999 & the reason I have to see him every month. I am on methadone because he feels like it does a better job of allowing you to function normally, drive etc., I also take a short term release oxycodone for break through pain. I still have bad days but they are far & few between, today is 1 of them but we have had rain for almost 2 weeks everyday & that is something that can increase my pain level. I enjoy my life with my husband, we just celebrated 35 years of marriage, we have 1 beautiful son & 2 beautiful grandsons, I think about what I would have missed if I had given into the dark thoughts when the pain got so very bad & the doctors we treating me like it was all in my head & I just wanted the meds. The methadone doesn't do anything but take away the pain. It takes a while to build up in your system, a week or so but as much as I hated the idea of taking pills everyday, I was willing to do this to have a life again. My pain level used to be around 8-9 out of 10 & since being on the pain meds its around 3-4 out of 10 on average. My doctor says no exercising with equipment at the gym but I went to our hospital based fitness center for water therapy, exercising in a warm pool & found that that helps immensely. It helps to do some exercising but be careful it doesn't make the problem worse by doing the wrong type of exercises. Now there are some pain doctors that are jerks just like in any field but trust your instincts & check out the doctor, make sure he or she is board certified. Get a feel from others who go there about what they think of the clinic & the doctor but don't get discouraged or give up after 1 visit. I would love to know how your 2nd visit came out. Hang in there, I know it can be fraustrating but its definitely worth the effort to find a good doctor whom you can trust & feel comfortable with. Good luck & hang in there.
 
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Arrow84 responded:
I have been going to a pain management dr. for over two years now. I first had an awful experience as well. I went to one located at a local hospital and was so upset that I did not go back. I then when to one who worked for a private practice. since I have been going there, my pain has been better and we have been working with a type of cortizone injections. In my personal opinion, pain management clinics at hospitals couldn't care less about you. The private practice ones are the ones who will take great care of you. I was also taking many pain, muscle, and antiinflammatory drugs. I have been able to cut out 50% of what I was using (if not more). The place that you went to should not need you to arrive at your next appointment in pain, and injections will help you greatly.
 
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fibropain1 responded:
Hi!

I am so sorry that you are going through all of this. I hate to say it, but I am so confused about pain management clinics. I have never known what they were exactly. I saw on the news that many have been sited in FL. because of a few doctors stepping beyond their boundaries, which makes it hard on everyone. Pain is a horrible thing to deal with hour to hour, day to day, 24.7. I like others wish there was a "quick fix," but I know my body and also try and watch out for me and I get other opinions.

I have chronic severe pain and fatigue (fibromyalgia and chronic fatigue syndrome), along with some spinal injury, etc. I am usually on the fibromyalgia board because this is my main problem - all over pain.

I have always wondered when you have an appt. with your doctor, do you take your meds so that they are working "well" for you when you arrive; then he/she see that you look like you are feeling well! If you do not take them, I would probably have to be taken in on a stretcher and screaming! There is really not much of a "happy medium" for me.

So, if you see me here sometimes, it is because I need some answers too and, so far, I have not gotten too many.

Hang in there and I hope things get better with you!

Ann
 
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fibropain1 responded:
Call and have a copy of your MRI and X-ray evaluation ready for you to be picked up. If you are in a state where they send reports to other doctors, then you can do this, also. You should have a right to your reports and then you can give these (after making copies of your own) to any other doctors that you go to.

If you need to go to another doctor and he wants to do the same MRI, you will at least have this written information in had and there is no questioning what is on paper. You also have a right to your x-ray films and any reports; you just have to sign for them.

If you do not watch our for yourself, believe me nobody else will. It does take time on the phone and when you are in pain, it is very hard, but they know this also. A lot of times you cannot seem to reach the correct office or particular office in the hospital where the x-rays are stored. But, the physician should have a copy of the report.

When I had pneumonia fro 6 months ( I could read how severe it was from the report sitting right here in front of my face along with the x-rays), but it is lengthy and technical.

Anyway, I was so ill and almost died. My doctor was personable, but he got tired of seeing me. I could not help it if I had pneumonia, but no antibiotic was working for me. I guess he was frustrated too.

One day I went in and MORE x-rays. HE looked at them and said, "GREAT, no more pneumonia!" I thought - GREAT! "Why do I feel so bad and why is this pain still with me?"

As soon as I got home, the doctor's office called, along with the Radiologist and said to get back to the office. The DOCTOR is not "trained" and it is not HIS field to read those x-rays. So, he did not see that the pneumonia was still there. THE RADIOLOGIST caught it.

I gave that doctor another chance and went back to him, yet having MORE x-rays done and MORE antibiotics pumped into me. NEEDLESS to say, I DID NOT GET BETTER From this doctor. HE was killing me.

So, I finally had the sense to change doctors! YAY! I stayed with him because he was nice, amiable and we had a good rapport. Well, that means a lot, but not everything.

If you have someone to help you that would be great in handling this situation.

I wish you much luck! Ann
 
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MsBunky responded:
I have recently been accepted into a Pain Management Clinic in Calgary, Alberta where I live. I have been dealing with chronic pelvic pain on top of Fibromyalgia/IBS/Interstitial Cystitis/Adhesions, so there isn't a single part of my body that doesn't hurt. it's been ongoing for several years now, and I don't want drugs to be my only choice of treatment, so my family doctor made the referral to the clinic.

My initial visit was with the doctor and the physiotherapist but the program I'm in is a team approach. I wasn't told to stop taking my meds before the appointment, but I'm sure that it helps the doctors understand your true pain level and limitations when you are unmedicated.

My team helped to confirm several things that were going on for me, and also diagnosed that I have permanent muscle damage in the pelvic area, which I didn't know about. There are also issues with muscles surrounding my hips/glutes and possibly some SI joint problems as well. None of these things were really clear before going to the clinic, so yes, pain management centres can definitely help clarify a diagnosis, or discover other problems. The thing is, it doesn't always happen in one appointment or even several...it can take time. If the doctor you saw disagrees with the radiologist, then he has an obligation to explain why, but he may be reserving that until seeing you again unmedicated.

Once they've had time to really check you out, it may be beneficial for you to be seen by other specialists, such as physiotherapists, kinesiologists, etc. Cortisone injections are good to a point, but not for all problems and often in limited use. You don't want that to be your first line of treatment if there are other options.

I think it's important to remember that just like individual doctors, there are good clinics and bad clinics. I don't think you can make a decision based on one appointment, so I would encourage you to have patience, hang in there, go to the next appointment and ask questions. Make a list if you need to...it's your body and you have a right to know what's going on, but you also have to allow the doctors ample time to make their diagnosis.

I am now scheduled for several appointments with regular physio, pelvic-specific physio, the kinesiologist, dietitian, and my doctor (to work on finding the right combo of sleep and pain meds). I have a nerve block scheduled in July as well. In addition to this, I have several group appointments to help with self management, exercise, and sleep...a secondary team approach to teach me new skills to cope.

I've accepted that I will always have pain, but I'm encouraged by the many options out there to help me live with it. I am not my pain, and I will not be defined by it. I am still in control.

Best of luck to you!! Pam
 
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freedom1960 responded:
My doctor wants to see me in any shape I may be in. He takes my word that my meds are doing their job or not. It's too bad your doc can't take your word that as long as you take your meds, you are able to cope, and without them, NO!

Good Luck!!!

Rick
 
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flowersblue responded:
First thank you for writing like you did/ Jessdes/

I have my first apt next week with a Pain Management Clinc and not sure what to expect. I guess what you went thru might be what I should expect.

I don'tknow why I'm being sent to this place? I got hurt on the job, so the Nurse for Workman comp called me to tell me that I was going. OK

I've been doing physical threapy for several months, thought they would send me to a "real" doctor, not pain management. I have pain, I have pills for pain, but don't take those pills unless I'm not working or I can't work/ I live with pain everyday like most of you I read/

I don't need to know that I should try shots but I don't want them.....I have read here and other places and decided I don't want shots! I get physical threapy so what do they have is different? I know I have L5 S1 bluging disk, I know I hurt my knee but nothing is broken/ I know that my hip never stops hurting, but under the "workman comp" they will not be looking at my back, hip or foot or ankle. Only the part I said hurt right when I had the accident..........ops I didn't know you better write everything down because it can come back and bit you! In other words only in those first few hours that all I felt was my leg hurting and knee/ So that is all the workman comp is interested in!!!! So since I have learn about those bluging disk they won't go there! So why go to pain management? I learn thru my threapy that my lower back is causing most of my pain.

So what I guess is these doctors or whatever they are, are going to turn off my case and that is it! So yeah like you jessdes what in the Hell am I going for? Why do come early 10min like you did? Only to be put down? Why do everything they want? Well I wish you well Jessdes.......... Hope you do feel better soon. Ruth
 
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msmachetti responded:
I AGREE 100% WITH YOU! FInd the right one. Do not be afraid to tell HOW YOU feel. Ask them to please listen to YOU and your body. Pain can be managed with the right doc. and the right wording. Stay with your head up, and make an appointment asap with them, let them know you are not satifsfied with how the appointment went and you are insane with pain. SORRY you have to go through this now. BEEN THERE!
 
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annette030 responded:
I don't know what kind of injury W/C is treating you for, it sounds like a knee injury. A bulging disc is rarely caused by trauma or an acute injury. Bulging discs are usually just a part of aging, it is always hard to tell if they are causing the pain or not.

Have you seen an orthopedic doctor yet? Did he suggest surgery of any kind for your knee?

A pain management doctor is a "real" doctor. They are real doctors who have additional training and certification for pain management. You say you are in pain everyday, go hear what he has to say. Maybe he will have something to offer, and if you don't want to do anything he suggests you don't have to. There are also other kinds of medicines to take for pain besides the traditional pain pills.

If you wish to, you can always go to your own doctor and ask for a second opinion. Maybe he has something to offer you.

Take care, Annette
 
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bluester10 responded:
have been going to pain management for 5 year,and to doctors and hospitals for15 years before that. it took me a wile to find the right doctor, and then the right treatment combination. still not sure if I have found the best treatment, but its better than nothing. anyway if a doctor wants you to arrive in severe pain just to satisfy his curiosity, he needs to, well you know , and you need to find a doctor. good luck, and don't give up.

p.s .my pain is 4/10 and that's not so bad


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