Hi all! I suffer from Thoracic Outlet Syndrome, Lumbar RSD, Left Lower Extremity Radiculopathy, and both cervical and lumbar stenosis (several herniated discs). Had this problem 3 years now from a car accident. I have both a cervical and lumbar Spinal Cord Neurostimulators that work wonders for me and I'm very pleased with them. My problem lies in when my RSD flares up and the stimulators do not work with the burning sensation on the skin's surface. I need pain meds to take care of that.

So, the bigger problem.... getting the pain meds. My Pain Management Doc (who performed the stim procedures) told me to get them prescribed by my Primary Doctor (as he does not want to be bothered with appointments for minor stuff). I'd been getting them prescribed by my Primary Doc, who then told me she does not want to prescribe them for me anymore because it is a Pain Management Doctor who should do so (I agree with her). Then I go back to my Pain Management Doctor, who wants to perform more blocks and ketamine treatments instead of giving me meds -- don't get me wrong, I love the blocks and ketamine...just don't last and I cannot afford them. PM Doc tells me the pain meds are not good in the long run and refusues to prescribe, continues to push procedures (more $ in his pocket, I know). I'd hate to leave my PM doctor, he does wonders for me when I need my stimulator programs adjusted, and is a genius when it comes to RSD. I know if I switched to another PM, records would have to be sent and if my current PM doctor knew he'd be MAD (he's got quite a temper). Been 4 months now with no pain meds and am going through a torturous flare with RSD

Anyone else have similar experience? If so, how did you handle it??

Gentle hugs Vanna

Personally I think the Primary Doc should prescribe because of your documented condition. After all, you're receiving meds for flares not everyday use, so, I would look for another PCP. That's my 2¢

Vanna, I have no words of wisdom for you. My PM doc does all the prescribing for my narcotics, and Lyrica. My primary does the prescribing for any "stupid" things I do like breaking parts and pieces. I have also gotten narcotics from a surgeon when I had multiple breast biopsies. I also have a psyc doc who prescribes antidepresants (currently Pristiq). All of my "extra docs" send info to my primary. I think as a PAIN MANAGEMENT doc he should give you meds for breakthrough pain. Try to explain that you cannot afford the other treatments, see if he can/will help you out.
VERY gentle z

Bummer...

My primary writes my pain meds. But my PM docs (multiple over the last few years) have made the big bucks...especially since I have United Health for personal use, which only pays my Primary about $48 for each office visit and nothing for a phone call when I request my refills. And I have WC for my injury, which has been used for many of my PM visits. My WC carrier is the Hartford and they have tortured my providers needlessly and endlessly, so my providers have truly earned their fees.

Sorry you are going through this and I sincerely hope you get it resolved soon. Good luck.

Sandy

All your doctors work for you so I would not concern myself with his temper or him getting mad. Your PM doctor knows that just recently the goverment is cracking down on PCP when Rxing narcotics. It has been noted many times over in the last couple of weeks in every paper is the US that PM doctors are the ones who should be RXing for chronic pain conditions. I understand that your situation is only for flares but I think he should do the RXing. Lets not forget he does all your blocks, ketamine and does maintenance of your neurostimulator.

I will never understand the differences in how PM doctor work. If I got a RX from another doctor or dentist and I did not have them call his office first he would be very upset with me and in a straight forward way would let me know. I quess I know better because I have never had a problems. He made it very clear from day one only he does the RXing. I don't have a neurostimulator but I have done in-patient ketamine and continue do to blocks as needed. Even if I have a surgery he is so involved with the anesthesia.

Good Luck

Gabbycakes

If only you didn't have such a brilliant doctor with such a massive ego, this problem wouldn't exist at all - but it looks like you're stuck with it and him. There's little doubt about this being the passing of the buck between your specialist and primary doctor who don't want the extra hassles associated with providing you the pain management you need.

What you're needing is what I refer to in my life as "kickers." This is nothing more than some kind of pain medication that you use for breakthrough pain. I've been using breakthrough narcotics for years and they've been a godsend.

With your medical diagnosis and prognosis, I don't personally see why your pain doctor is giving you such hassle other than he prefers his other more profitable treatments. This irks me more than you'll ever know and yes, I have experienced this firsthand myself. Doctors who are into Trigger Point Injection Therapy and all the other different types of treatments that cost the poor patient a small fortune do have their financial gain at heart more than your care I'm sorry to admit.

My question is, what kind of relationship do you have with your primary doctor? Are we talking about someone you can talk to about anything and everything and who really cares, or are we dealing with someone who just pushes you through like you're just another card in the deck that needs to be dealt, but that's not really given much attention to? If you've got a close and solid working relationship with your primary, then I'd tell him how you feel and what your concerns are about the problems with moving over to another pain doctor. You need a doctor who can still work with your stimulator but who's not scared of writing out the scripts where the feds are looking over their shoulder all the time. Doctors who write out narcotics do have a long list of prerequisites that must be met and maintained anytime there's narcotics involved.

I'm personally fearful that till you get some breakthrough medication for when you're dealing with the rough moments in your day, you're going to just keep suffering. Even once you do find a new pain doctor, these are relationships that slowly build over time so don't expect perfect results the first time you see him/her. I've been with mine for over 9 years and it's a relationship I take very seriously. By always keeping complete honesty and never over-inflating, but simply stating the facts, you'll be on the right road.

Like it or not, there are a whole lot of people out there screaming day in and day out over pain that's really not that bad. By the time a patient such as yourself comes along with real damage, the doctor is totally burned out and just assumes that you're one more of the complainers who's filled his waiting room that day. It's not just the doctors fault, it's the patients I'm sad to say who have created this problem for you.

As far as you becoming addicted, the numbers just don't stack up. Of the patients who are in real chronic pain, most reports show that only 1 to 3% of the patients who take narcotics ever really get hooked, yet most are treated like they're junkies by the press, family/friends, and medical professionals. Only your good reputation will overcome these prejudices over time.

Best of luck and keep me posted on how you're doing. This is no easy problem to solve, but you do need the help that's for sure. Bob.

I agree with all above. My Primary will not prescribe any of my pain meds. I told him that PMs are just a racket!!! I too have SCS and am no longer VALUABLE to PM. Had check-up yesterday and all he wanted to talk about was putting in a pain pump!!!!! I told him NO WAY I am just over the SCS surgery of 2 yrs. ago!!!! We are just $ signs!!!!! Sorry I too am venting. God help all of us with RSD. Fondly-Carol

I am very lucky to have a WONDERFUL PCP that will give me pain medicine.. unfortunately (and, if you read my post, I've been diagnosed with peripheral neuropathy... and am wondering if I have RSD, but do not know if I do or not.. but also have 5 things wrong with my back since I was a young child--so I am no stranger to chronic pain) even strong pain medicine does not touch my pain. So it doesn't do me any good. Wish I could give you guys my medicine--it's useless to me right now.

Bobinjeffmo,

I think you nailed everything exactly in the head! Yes, my PM is excellent and egotistical .... and I am lucky and grateful to have him. I want to stay with him. I once begged him for some pain meds and he prescribed me 15 percocets and told me not to take them -- ha ha! This from a man year earlier who tried to give me morphine to take on a daily basis and I refused. I don't mind being in some pain ... it's that severe breakthough crippling pain I have a problem with. And, fortunately, an addiction problem is not something I've ever had an issue with. After 3 years, he should know that is not a problem for me (although I do understand your point in that it is a problem for many and I'm sure he's looking out for me).

My PCP is someone I don't have a long relationship with (moved to my new hometown little over 4 years ago). She does not really know what RSD is and thinks I am crazy for getting my Neurostimulator implants. Ahhh..... if she only knew!

So, you are also correct that I try to suffer in silence, hoping the flares will pass. Just hard to keep moving and put a smile on my face for my little ones when Mommy's legs and feet feel as if they are on fire

Thank you all for your input!!! Vanna

The hospital that I get treated at will not let pain mgmt. docs write scripts for pain meds more than a few months. They send you back to your primary doc for long term scripts. My primary doc is super supportive & has no problem prescribing my pain meds. Although, he wishes that the pain mgmt. department would write them because he thinks they probably know more about which meds/dosages would be best for me.