Question about Pain Management

[Caldestin]

Hi, I'm new here. Over the past two years I have been prescribed Lortab 10/500 for severe knee pain. I have a torn miniscus and ACL in my left knee; plus, extremely bad pain in my lower back. I am a 26 year old man. I started seeing my doctor two years ago when it was first prescribed (PCP); I got X-Rays and a MRI completed last year. Over the past 4 months, the pain has worstened to a point where I cannot stand. I am not a addict. I have always taken my Lortabs as prescribed. Today, I saw my PCP and let him know that the Lortabs were not working as well as they used too, as well as voiced my concerns about the tylonal that is in them. Actually, I've been mentioning this to him for the same 4 months the pain has increased. I asked my PCP if there were other options that we could go down; or if he could possibly let me try another type of medication. His answer was a straight "No, youll be fine on this," and then went to prescribe my Lortab 10/500 plus some medicine called Baclofen 10 MG; which, from what I read is to help alcohalics stop drinking and its a anxiety medication (I have never been depressed.) So, this afternoon, I went ahead and contacted a Pain Management Center here in Las Vegas and schedualed a appointment for next Monday. What I want to know about Pain Management is as follows
1. Will the doctor I see be able to still help me get surgery on my knee; as well as prescribe me something to take care of the pain?
2. What can I expect from the first visit.
Thanks for any input; please note, I am not a pill seeker/addict/scumbag; I am just in a extremely bad amount of pain.

[Ashelen]

I understand all of your frustration and I agree completely that age should have no impact on a doctor's willingness to treat a patient to the full extent of their abilities.

But the sad fact exists that it DOES affect most doctors, and I understand why. First of all, if you discuss remaining on Hydrocodone/APAP 10mg I would ask to switch to Norco in leiu of Lortab because Norco has 10mg of hydrocodone but 325mg of APAP instead of 500...this is what I have been taking and it's the same medicine you take, only my APAP is lower (APAP=tylenol although I'm sure you know that LOL).

I say it wouldn't be a bad idea to ask....but you could always just give it a shot. even if your PCP isn't willing to prescribe anything higher at least you won't be left cold, so you can always go back to your PCP for awhile until you find a better Pain Management doctor if they end up being unwilling/unable to prescribe something....just remember to pick one or the other because PM doctors are VERY strict about patients only receiving pain meds from one doctor....I even had to call about my emergency room visit (I fell 2 days ago) and let them know what medicine they gave me while at the hospital.

Like I said..I understand completely your frustration. I hate that my age impacts my ability to be treated, but I fear that it will until I am much older. Hopefully you and I are both able, in the near future, to find doctors who are sympathetic and caring and who see us as people with pain, not young people needing pain medicine...there's a HUGE difference.

best of luck, feel free to msg me if you have any more questions...I'm new to Pain Management but I'm sure we've faced a lot of the same issues over the years so I can definitely relate.

[Caldestin]

I'm picking up my X-Rays of both my knees as well as the MRI I had done 3 months ago. The person at reception told me if I could bring my medical records from 5 months prior, that would be good, but it is not requred. I am also planning on bringing my current medications with me (i.e. my Motrin 800, Lortab 10/500, and Baclofen 10 MG.)  My PCP never ran a test on me in the past 2 years to see if everything was ok with my liver, that is why I am so worried about the tylonal content in the Lortab.
Do you recommend that I contact the Pain Management center about the doctors prescribing? When I called and schedualed yesterday, the nice receptionist lady told me that they were accepting new patients and that I did not need a referral. I also verified this with my health insurance. Like I said before, my PCP is not willing to help me with the pain I am in while I am finacially struggling to find the money for the co-pay for the knee surgery.

[Caldestin]

Ashelen,
The thing is; like I said before, the Lortabs have stopped working, and on top of that I dont want to blow my liver; its really important to me. I took the Baclofen last night and it really didnt do anything for me. I really hope everything will work out on Monday and the PM specialist that I see will do long term, up until I get finished with my surgery. That and possibly prescribe something stronger, that will work for the pain I am in everyday; with the exception of Tramadol considering I have a bad history with it (I'm not able to sleep at all; I get nausious; and when I try to sleep on it, I stop autonotomous breathing.) I really hope the doctor I see will be caring and not treat me like I'm a drug addict (i.e. saying "Well, unfortunatly, I will not be able to prescribe anything except for the same medication you have been taking for 2 years.) The thing is; I feel that it should not depend on the age of the person they are seeing; but the amount of physical pain the person is in everyday.

[namnam46]

I waas typing when Ashelen was typing.  :{  I'm REALLY happy that Asheln answered you as she is JUST about the same age that you are.  Sometimes it's VERY hard for a young person to get the help that you deserve!!

I didn't mention the Urine tests because I didn't have any UNTIL I'd been going to my Doctor for ALMOST a year.  I think there are MANY PM Doctor's that give them on the VERY first visit and quite a few that WILL give them on EVERY visit.  You'll just have to see what yours does.  I'm sure that you WILL be signing a PM Contract and that is something that you NEED to READ and understand ALL of the ramifications of it.  IF you break even ONE RULE then they CAN and usually will dismiss you.  IF that happens then it may be VERY difficult for you to get the help that you need.  ALL I'm saying is to BE SURE YOU FOLLOW THE RULES!!!  If you do then you won't have ANY problems.  :)

As far as the Baclofen, no I haven't had ANY side effects at all from it.  I know that MY PM Doctor put me on it INSTEAD of the Flexeril  that I was on BECAUSE Baclofen would target a SPECIFIC muscle INSTEAD of ALL of them.  I've been having knots in my muscles and it will target the muscles with the knots and leave the others alone.  Therefore, whatever muscles are causing you the most problems it will zone in on those and not so much on the others.  That's the way that my Doctor explained it to me.  :)

I HOPE that this helps you a little more..........Sherry  :)

[namnam46]

Hi Caldestin,

First I want to welcome you to the Pain Management Forum and let you know that we are glad you found this Forum. I want to let you know that there are NO Doctors on this Forum only CP - Chronic Pain - Patients that help each other with our OWN expertise and experiences that we have developed through our OWN CP Issues.

I'm sorry that you are suffering this way at such a young age!!  I have a PM {Pain Management} doctor.  My PM Doctor is the one that sent me to my Orthopedic Surgeon.  I just had my 3rd artificial hip implanted last September 8, 5 months ago.  :)

Gemini IS correct about the the Baclofen.  I take Baclofen for my muscles and it helps a GREAT deal along with my Percocet and Fentanyl Patches that I use for my pain.

You SHOULD get added relief from the combination of your Hydrocodone and the
Baclofen.

The FIRST time I met with my PM Doctor he gave me Pain Medication.  HOWEVER, not ALL PM Doctor's do this.  I had EVERYTHING FULLY documented AND I was REFERRED by a Rheumatologist to my PM Doctor. You, on the other hand, made th appointment yourself WITHOUT a referral and your PM Doctor MIGHT not give you ANYTHING the first time you go WITHOUT your records AND additional tests.  I could be wrong BUT just be prepared!!  You WON'T know what your PM Doctor will or won't do UNTIL you get there.  :)

PLEASE let us know how it goes and what he says. I wish you the VERY best of luck!!

I'll be lloking for your update............Sherry  :)

[Caldestin]

Thank you,
Have you ever taken Baclofen??? If so, were there any weird side effects??? Like randomly falling asleep or hallucinating?

[Ashelen]

I actually can answer this question fairly accurately as I just had MY first Pain Management appointment. I, too, have been taking Lortab (well, Norco) for years and am young -- only 25. I can tell you that they're going to do everything under the sun to avoid putting you on a stronger med at our ages. Baclofen is an anti-spasmodic and muscle relaxer that is, yes, used to control DT symptoms with Alcoholics and is mainly used to treated people with Multiple Sclerosis. It doesn't sound like a great match for you, but I'm not a doctor so I don't know for sure.

I, too, had to recently just put my doctor of the past 8 years behind me and move on to Pain Management because he wasn't addressing my needs adequately. During my first PM appointment, I filled out a BUNCH of paperwork, then I went to the back and was asked a few questions from a nurse. I was put in a gown and the doctor examined my back, my neck, and we discussed what issues were the most intrusive into my life, and got a basic game plan in place, including ordering X-rays and sending me to a plastic surgeon to talk about a breast reduction. He also agreed to write me a script, for when my current script runs out, so sometime next week I will be getting my first script from him. If my current script had run out, I have no doubt that he would've written a new one then and there and sent me home.

I had to do a urine screen and sign a pain contract, and then we scheduled some new appointments....and that was it :-). Simple and to the point. And what I had been begging my neurologist to do for 8 years (send me to a plastic surgeon to talk about a breast reduction) my PM doctor did on the FIRST visit. I was very happy.

I do caution that you do some research into the PM clinic that you are going to. Apparently the doctor I was put with does NOT do long-term Pain Management and I will have to transfer after a few months. I did not realize that going into it, or I would've requested to be sent to his partner who DOES do long-term pain management. So make sure you know exactly what services this doctor can and will provide you with.

Also...very often you will have to call and verify that they even prescribe in the first place. Some PM doctors do NOT prescribe. So you'll want to call and check about this. Have all your records and recent tests ready...and just tell them that you're simply unable to live with the pain management care that you're currently receiving and that you're excited to embark on a new chapter of your life that will hopefully present you with new options; that's what I told my PM doctor and he said "I hear that so often...people are SO relieved to have someone who is capable of actually HELPING them and LISTENING to them".

Good luck!

[geminigirl1963]

I can't comment on what you can expect from your first pain managment visit, as my PCP prescribes my pain meds, so I do not go to a pain management doc.

However, I do know, in my case anyway, I had to see an orthopedic surgeon for my shoulder issue that resulted in surgery.  So I'm presuming that's the type of doc you'll need to see to be evaluated for surgery on your knee.

Baclofen is actually a muslce relaxer which, if you take it along with your Lortab, you may find that the combination helps your pain better than the lortab alone.  I'm guessing that is also what your current doctor was thinking when prescribing it - rather than changing your pain med or upping your dose.

Best of luck with your PM (pain management) appointment - let us know how you make out!