why me part 2

[jake321]

i have found a new pmd and still get nowher my 1st appointment i goto with my mri and pevious med bottles and he gave me an ua and prescribed me saboxen well i dont understand but he says by law i have to take them before he prescribes andy narcotics before the appointment he was aware that i had fax to my prevous dco for records but they have not sent them why make the appointment if he was just going to tell me he wanted to investigate my records and does suboxes help pain if not i dont need it.i think of just giving up im a big boy i think i relieve pain just not to deal with these gods i mean docs.
any help with mri reading also opinion of how severe it is
L5-S1 moderatly narrowed with with dehydration and central annular tear. mildcentral annular buldging is contained within anteria extradural fat there is no focal mass effect on exiiting or crossing nereve roots.
mild central degenerative annular buldging at L% S1 level no mass effect

[Tuckamore]

Hi Jake,

I am so sorry to hear that you are being treated so poorly. I have never heard of law that  requires PMP to treat one with suboxone prior to narcotic therapy. You have not provided the state in which you reside in so I cannot investigate his claim.

It is my understanding that suboxone is not recommended for pain management and indeed it will have no effect on pain. It is normally prescribed for withdrawal symptoms from opiates. I did go to the website and it said this:  Do not use SUBOXONE or SUBUTEX for conditions for which they were not prescribed. Patients with a clinical need for analgesia should not be transferred to a SUBOXONE regimen. SUBOXONE is not indicated for pain management.  So unless there is something I don't know your new PCP is currently not treating your pain.  

How bad is your condition based on the MRI results? A tough question. We do not all respond to pain the same and an MRI does not always provide the complete picture. There have been numerous times that following a surgery the surgeon will state that the MRI did not show the extent of the damage or the severity of the condition. So that said I can give you my personal opinion based strictly on your MRI.

Moderate narrowing along with the dehydration and annular tear should cause you moderate uncomfortable and activity reducing pain with flares of more severe pain. However I have know ppl with mild to moderate narrowing that have extreme pain so pain is very subjective. That fact that the MRI does not reveal any nerve compression should make your pain more controllable. However things can change rather quickly and a new MRI should give a better idea of where you are today.

Mild central bulging at the L5 and S1 should cause minimal pain to possibly moderate pain but it is a point of motion and great stress so again there are just so many variables and pain is subject

I've seen a lot of different reactions. As an example, a man about 50 came into ER with his hand mangled, a finger hanging and very bloody from getting it caught in a corn picker. He never moaned, grimaced, shed a tear or asked for pain medication. We had to insist he take something before the tests and further examination. Another man about 30 came in with a small piece of wood in his leg, like a very large thick sliver. We heard him moaning and swearing the minute he opened the door. He was begging for something for pain, which of course was given to him. I would have thought the 50 year old was in much more pain but who knows?  

How are you managing the pain without narcotics or any thing to control it? How cruel of the PMP to offer you nothing. Thanks for the update. I'll look forward to hearing from you again soon.

[kolo13]

Buprenorphine (the opiate in suboxone) was originally developed as a pain reliever and is still indicated for moderate chronic pain. Some people who no longer want to take full-agonist opiates for pain do get some relief taking suboxone. I think that you will also find that some pain management doctors, upon taking in a new patient, want to evaluate the possibility of pain caused by opiates. While opiates do a wonderful job alleviating acute pain, they obviously have their problems for managing long-term chronic pain. One of these is the paradoxical effect whereby in some patients, as tolerance develops over time, the opiate increases sensitivity to pain. Thus there are some patients taking opiates to relieve pain that is substantially caused ( or rather worsened ) by the opiate itself. While this takes some time and work to discover and evaluate, a doctor with a new patient can get some idea of a patient's dependence and tolerance without throwing the patient into full blown withdrawal by substituting a short course of suboxone fot their current opiate regime. Now I, of course, don't know what your doctors intentions were and I've never heard of such a law as you mentioned, but he could have been referring to the intense legal scrutiny these doctors are under to justify every single prescription of opiates they give out and this is a method he uses to initially evaluate some new patients. And while the appointment might have seemed like a waste of time to you, he had to see you, examine you, talk to you, and give you a UA - and get the results back - before he can do anything else. Laws and regulations do require him to jump through a number of hoops before he can give a new patient narcotics. And while you resent his god-like power over your life I'm sure that no doctors feel like gods these days, what with the number of people looking over their shoulder and second guessing their actions, many of whom have the power to take away their ability to make a living. I would recommend that you have a little patience with your doctor's need  to do some of these things and that you ask him to more fully explain the purpose of using the suboxone. They really are not allowed to say "Oh, I see you have an MRI and some empty pill bottles, let me fill those back up for you."  They are absolutely required to do a full and thorough evaluation of you situation and needs first. Good luck, I hope you find help for your pain.

[Mollyrae]

Kolo...Very good comment, I am impressed.

Jake, It seems that you have not found the Doctor for you. Some ppl click and others just don't. I just found pain management for one of the members here and it may be possible that I could help you. She just had her first appt. today and it went wonderfully. I was so glad to help. If you'd like, you can send me a Pm and we can work on it.

I feel that the Doctor should not have prescribed Suboxon. There are a hundred other things that I feel would have been better than that.

Like I said, please feel free to send me a pm. I am always here. Please take care and good luck in what ever you decide to do.

Warmest regards,
Mollyrae