Hi,

I originally posted this on the spinal forum, but thought after it should probably be here instead...oops.

I FINALLY got an appointment with a pain doctor (been on a waiting list for a year, here in Ontario we don't have very many available and taking on new patients). I'm relieved that someone is going to deal with my ongoing chronic pain, and not just talk about surgeries and recoveries.

I know many of you have been to pain management doctors, and I'm hoping you can help answers questions for me and offer advice on what I should be prepared for.

What should I expect my first visit? What sort of questions should I be asking? What types of treatments should I be suggesting or talking about for my issues? (I think most know my condition, recovering from ACDF with titanium plate/screws-C5, C6, C7, with double crush on my ulnar nerve, with peripheral neurapathy down my right arm with chronic pain in shoulder, traps, scalene, arm, fingers, numbness & tingling in last two fingers of right hand, loss of muscle and use of right hand, and it goes on and on...)

My biggest complaint is like everyone else, dealing with the chronic pain. I currently don't get enough pain meds to cover my pain and I'm struggling to make it through my days with everyday activities, and I still am not back to work yet. I only get percocets (enough for 6 a day) from my PCP, and cymbalta (60mg daily) and muscle relaxers.

What are some suggestions to make the best out of this first appointment?

Any suggestions will be helpful.
Thanks,
Cathie

Hi Cathie,

Don't mean to but there's so much out there by people who've said it far better than I can....

Google: talk doctor pain
Google: pain management first visit

I would focus on the second/third parts of that rather than the first. Pain management isn't always/just about meds. That may be one avenue, but hopefully as a stopgap until finding something else that works.

Doc

Your first visit will probably consist of a physical exam -- he'll probably look you over --- especially look over your injury site & range of motion, etc. He'll look at all your films & report & ask you lots of questions about your injury.

Then he'll probably discuss what he plans on doing "to" you, i.e. steroid injections (which *I* think are useless). I've NEVER had one that worked and I've had ALOT of them. And MANY people I've talked to have said the same thing. These injections are temporary too -- IF they work, they may last anywhere from one week to one year. But I have NEVER known ANYONE who had one work for a year. There is a limit to the number of injections you can have in a years time too. Also, if the first injection doesn't work, do NOT let the doc do another one cause if the first one doesn't work, the second one won't either.

Your BIGGEST concern should be pain relief. Make sure he KNOWS what you have taken in the past, and what has worked and what hasn't and the dosages. What works BEST are the opiates -- i.e. MS Contin, Oxycontin, Methadone, etc. Drugs for the burning-type pain caused by damaged nerves are Topamax, Gabapentin, Lyrica, Neurontin, etc. There are also muscle relaxers -- I can only think of a couple, such as Soma & Flexeril.

It's really best not to ask for specific drugs -- they tend to think you're a drug abuser when you do. Go figure -- I guess we're not supposed to read articles. But I would be ADAMANT about wanting PAIN RELIEF because you've been suffering for so long!!

I wish you the very best. I've been a chronic painer for more than 25 years, so I can sympathize with you. Please let us know how your visit goes, ok? God bless & take care. Hugs, Lee

Thanks Lee, that's the information I was looking for. I was wondering about those injections, I was guessing that would be first on his list of "tries" since it doesn't involve him writing a pain script.

I will make a list of what I've taken in the past and what worked best for me and take that with me.

Thanks again for your help, I will post how it goes.
Cathie

It may involve writing a scrip (or order) for the steroid, but since it's all handled internally, you may not see/know about it.

FWIW, my results were mixed. I had some that didn't work at all, some that worked for anywhere from a few days to a year, and in a couple of cases, indefinitely. With these injections, finding the correct injection point is critical, and can make all the difference between success and failure, which depends on the skill & experience of the doctor doing them.

Doc

Hmmmm.... yes, skill does me a lot when injections are in order. I've had some nurses give me IV's and it's quick and easy and painless, and others that struggle and try over and over and you just want to slap the **** out them for not knowing what they are doing.

I'm concerned about it, but as any one of us can understand, I'm in so much pain I'll try anything for some relief.

My appt. isn't until Friday, I'm trying to learn as much as I can about options before I go. I believe he is also an anestesiologist, so I'm hoping he is good at what he does! We don't get many choices here in Ontario, gov't run healthcare doesn't allow us to pick and choose our doctors.

Thanks for the info!

I know where you are coming from, believe me. I , like you have an appointment with a pain dr next week and jsut want some kind of relief from the constant pain. I have tried PT, Epidural blocks , several different pain meds and have not found anything as of yet that helps enough to say. My pain only seems to be getting worse if anything. The pain dr I am seeing has many different methods they try so I am hopeful that I will get some kind of relief soon. I wish the same for you!

I've been on a Butrans pain patch for a couple months now, and only taking Percocet for breakthrough pain, it seems to keep things under control as long as I don't over do anything. Considering I had another surgery on my arm 4 weeks ago I. Happy with the pain control thus far. It's not perfect, but is very manageable most days.

Good luck with the dr, hopefully you get a good one that listens and understands!

Cathie

I have never experienced any relief from from the infamous procedures. On the other hand, if I were changing pain docs, I would tell him/her about the lack of success but was willing to give it one more try if he/she thought it worth a try. I would try to keep my side of conversation focused on the degree of pain, how it effected my quality of life and my desire to improve my level of function. Best wishes.