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My Primary Care Physician won't manage my pain appropriately. What can I do?
An_223268 posted:
I've had moderate low back pain and moderate to severe right sciatica for the past 4-5 years. I also have several other non-pain health issues that all combined to qualify me for Social Security disability. Once I started to receive Medicare this past February, I found myself a Primary Care Physician to help manage all my care. Well, since my back pain has progressed to the point where I can barely function any more, I asked him to address that issue first. (My pain level is a constant 6-7 with "spikes" up to a 9-10) He was certain that it was only muscular in nature and prescribed Flexeril and said to return in a month. Getting zero relief from that, he then had me try Tramadol. Again, I was told I had to wait a month before coming back if it didn't work. Again,zero relief plus bad side effects. He then tried 1(one) Darvocet 100-N 3x/day. Nothing. He sent me to get a back x-ray at that point, and told me to come back in a month again. I went to ER 4 times in that time frame, and they suggested an MRI. So, FINALLY he sent me for the MRI and discovered that at level L4-L5 I have a synovial cyst protruding into my spinal canal and right foramen that is producing moderate narrowing in spine and right neural exit and compressing the nerve root. I also have at L5-S1 a broad-based herniated disc. He read the radiologist's report and wrote me a referral to a neurosurgeon. When I asked him if he could give me something that would control my pain since it hasn't even had the edge taken off unless I go to ER, he put me on 1(one) 5mg Vicoden twice a day, and told me that if I came back in a month and asked for more he'd make me sign a pain contract. That would be fine with me if my pain were anywhere close to being managed! I have been taking both at once instead of AM & PM, which DOES control the pain, but I only have 4 hours of relief a day! He won't listen to me when I tell him that, and I am SOOOO tired of hurting! (By the way, I do have surgery scheduled with the neurosurgeon to remove the cyst, but he's not going to do a fusion yet at the other level because he believes that the pain is originating from the cyst compressing the nerves at L4-L5.) So, what can I do about my PCP and his reluctance to make me even a tiny bit more comfortable???
cdoggg674 responded:
My advice is find another DR. he sounds like one of those Physicians that is scared to death to give any patients adequate treatment. You can blame that on all the drug addicts plus the DEA is basically scaring many Dr.'s to the point that you could have bone sticking out of you and still be hesitant to give you something strong. I have the same pain, in my lower back, L4,L5,and S1. The lortab he has you on will only give you a quick fix, you need to be prescribed something long lasting, and plus Lortab for the breakthrough pain. But like i said, go find another Dr.. I honestly can't stand these Docs that assume if they give you narcotic pain pills you will become some drug addict. Thing is though, many do but... these narcotic pain relievers work, period. If a person starts abusing them etcc.. they are grown and they should make mature decisions. In no way shape or form would I blame a DR. for someone getting addicted to pain pills.
tired_of_pain replied to cdoggg674's response:
Thank you for your input. I think that after my surgery, if I am still having pain, I will look for another doctor. Are there any types of doctors that are better to see for chronic pain management than others? I live in a rural area and there is only one pain doctor within 40 miles, but he will not take Medicare so I'd have to pay cash and I can't really afford that right now.
annette030 replied to tired_of_pain's response:
I personally think that any doctor who does not accept Medicare is of questionable use anyway. Just my opinion.

You might ask the surgeon who he would suggest after you have the surgery and see where your pain stands. Surgeons are generally not well trained in pain control of chronic pain, but he may know someone else in the medical community who is. My pcps have mostly managed my pain. You may need another pcp.

Good luck with the surgery, maybe it will fix the pain for you.

Take care, Annette
painon responded:
After suffrering with back pain for years and have three bulged discs just to get started, I highly recommend a pain management dr. They will make you sighn a contract and random urine screens but it sure beats the pain I know you are going through. My thouhgts and prayers are with you. Dont give up. If nothing else, if you find yorself back in the ER, see if they can refer you to someone in pain management.
greeninyork responded:
Ask your Neuro to prescribe something. He should have a clue as to the pain you are in!! Oh, and don't ask, Demand!! Tell them your PCP isn't prescribing you adequate pain relief and you are in misery (which you are) You have to stick up for yourself or they will walk all over you.
tired_of_pain replied to annette030's response:
Thanks for the good wishes! It is now 1:01 AM, and I have to leave to go to the hospital for surgery in 4 hours...I am so anxious to get this done and find some relief that I can't sleep! Well, I couldn't sleep due to my pain level, but the anticipation isn't helping me to relax. I sure hope that this will take care of it.
tired_of_pain replied to greeninyork's response:
You know, I tried that already but the neurosurgeon told me that he only prescribes for post-op. He did, however, give me a referral to a rehabilitative sports and spine doctor to see after my post-op visit because my neck has been bothering me some and I've had a bit of right radiculapathy. I had a C5-6 fusion done in 2003, and it appears that I may be developing some problems now both above and below. The pain in my back and leg is SOOO very much worse, though, that I barely notice the neck pain right now. I hadn't really thought about it, but I'll probably feel it a whole lot more with my back fixed, won't I? (HOPEFULLY the surgery fixes me!)
tired_of_pain replied to painon's response:
That's what my primary care doctor was trying to tell me he would make me do with him if I needed more Vicodin after I see him again. I am more than willing to sign a contract and take any drug tests they want to do, but I want assurance that I will receive adequate pain relief if I do so. He thinks that 1(one) 5/500 Vicodin twice a day should be more than enough and is unwilling to increase the dosage and/or the frequency! I take both at the same time, which only just takes the edge off a bit, and usually I take them at bedtime so I can doze off unless I have to go somewhere. If I have an appointment or have to go anywhere else, I take both just before I leave and cram everything I can do into that 3-1/2 to 4 hour window of pain relief before I go back home and just cry because I overdid it and the pain is even worse when the pills wear off. I just can't stand it anymore!!! Surgery is in a few hours, thank God, so I'm going to go try to rest and hopefully it works out well! I'll report back on this board when I get home and can manage to sit at my computer again.
Surforever responded:
Anon, my heart goes out to you. My PCP was the same way, but he finally referred me to Pain Management. Bottom line is this; your doc mother did not name him Doctor. and remember, he works for you!! If he isn't doing his job, fire him!!
annette030 replied to tired_of_pain's response:
How did your surgery go?

I hope all is well.

Take care, Annette
Geradine4733 responded:
I share Annette's concern - how did your surgery go? Please keep us posted. We care.
Deniset999 replied to Geradine4733's response:
I am going through the same pains. Did your surgery go well? How are you feeling?
jbigboy57 responded:
i had fusion surgery in 2006 L4&L5 still in pain daily i have oxycodine for pain witch i dont use very much because i have my grandkids also i have pain in my neck C6&C7 HAVE HAD SEVERAL INJECTIONS all were tempurary relife im trying to get a apointment with a pain clinc i hope and pray for you change doctors good luck
An_223269 responded:
Know exactly what you've gone through and know many others undergoing the same. All these quacks want to do is run up a huge tab and still not help you. It's the Stone Age mentality. Once you've become ill or disabled you're not productive any longer and you become a fourth class citizen. Best of luck to you and all others.

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