Do primary care doctors manage chronic pain?

Question

I just cannot understand why my primary doctor cannot manage the prescriptions for my chronic pain? I have rheumatoid arthritis, fibromygalia, and suffer from reoccuring migraines. I have tried different routes, but narcotics seem to only be the route that helps me to function enough to do what I need to do. I also have high tolerance to narcotics, or any medications at that matter. My doctors have labeled me as a seeker as a result... what can be done to get the help I need?

denise115 · Answer

You sound like me. I have fibromialgia, RA, and just had knee surgery. My doctor that was treating me and keeping me on the right combo of meds moved out of texas, sso now Im trying to find a new doctor. I m not having any luck finding a doctor to keep me out of pain so I can work without pain. Im a single mom of 3 and I have to work but sometimes i cant get out of bed. I just want a doctor who understands the pain and that will help me so I can support my kids. I also have a high tolerance for meds. Goodluck I hope you find an understanding doctor whos not affraaid to give you the medicine you need.

GreyScale · Answer

Yes, I am currently under the care of a rheumalogist. I am recieving Humira shots from him, as well as steroids (which I am tapering off of.) For the longest time, I thought my headaches and widespread pain were from my rheumatoid arthritis flare-up! Once I started the shot, I felt better 3 days after my first dose. My joints were not as stiff, tender, or red. However I still had the widespread muscular pain and it hurts to touch some areas. My rheumalogist did the trigger-point test and all/most are tender or got immediate pain reaction from me. So he said that I have fibromygalia as well, and that could be what is causing my migraines!

I have tried all of the abortive medications, beta blockers, etc without any success. I have to go to a head-pain clinic this month, but almost feel as if I should void that appointment and just go to my pain specialist next month. Yes, I finally got an appointment with a pain specialist. 

My PCP is godsent. I almost wish I didn't have to go to a pain clinic because he allows me to talk to him without feeling as if I am crazy, or just want narcotic, or whatnot. 


I just wish I didn't have to live with this. I am blessed with a beautiful little boy and I feel as if I am missing out on a lot. His father is also a chronic pain patient... it makes it very, very difficult!

Thanks all for your replies! 

Much love,
  Grey

jamlws · Answer

My family dr is treating me for now, she won't treat me "long term" I am waiting to get into see a pain specialists that she reffered me too. I hope you find someone that will treat you and I am sorry you are labeled as a drug seeker. 
Good luck,
Jamie

Tuckamore · Answer

I agree that trying a rheumatologist may get you better releif. If you have not tried that route it should be considered. I should not assume that because you said "doctors" and fibro that you have already gone that route.

Just don't give up. A good physician will beleive your pain and treat it appropriately.

~Tuck

namnam46 · Answer

Hi,

I'm so very sorry that you are in such pain. When I moved to Arizona last summer, I was very fortunate to find the most WONDERFUL PCP. He saw that I was on Lortab 7.5/500, which was not helping me at all since I'd been on the same med and dose since, 2003, for my DDD and arthritis and immediately on the first appointment sent me to a Rheumatologist.  

I was there for 15 minutes and he looked over my history and immediately changed my meds to Norco 10/325 and sent me to the greatest PM Dr.in Arizona. The first appointment he gave me a huge selection of meds to choose from and we decided on the Fentanyl patch and Norco 10/325 for BT. Since then I told him that the Norco (Hydrocodone) didn't seem to be working anymore and he immediately changed it to Percocet. Sorry for going on like this, but the point is that I think if you can get a referral to a Rheumatologist that he/she might understand your pain and possibly be able to give you some relief.

Please keep in touch and hope that one or some of the wonderful suggestions that have been made in some of these posts above can help you.

Best wishes...Sherry

dame_wilbur · Answer

Do you have a specialist like a rhumatologist and/or neurologist? I'm asking because you don't mention any preventative or abortive medications in your post. I have status migrainous and see a neurologist for treatment. He has me on multiple Rxs to try and help manage the disease without resorting to painkillers such as narcotics. If you have reoccuring migriane, I wonder you don't have a medication such as a triptan already, like Imitrex, Maxalt, Zomig, and others to try and abort the migraines from really settling into place. There are also preventative medications, such as anticonvulsants, anti-depressants,  atypical antipsychotics, and NSAIDs that you can take daily to try and prevent the migraines from starting in the first place.

My understanding is that there are also preventative or at least daily medications for RA and fibromiagia. 

If you PCP is lableing you as a seeker, it might be just because they don't know enough to help you in ways other than the narcotics that he's prescribing you. 

If you haven't got them, I would *highly* recommend getting at least trying to get a referral to a rhumatologist and a neurologist. These specialists would be better able to help you in other ways than just narcotics.

Good luck and keep us posted,

~Dame

Tuckamore · Answer

Hi Grayscale,

I don't know what state you reside. Some PCP do mange their CP patients pain. I live in Wisconsin and it is our PCP that follow and prescribe for us. I was told this is because we are such a rural state that expecting us to drive hours for PM was not feasible. 

So it depends on your state. We do have PMP but they do not prescribe opiates. They do treatment, some diagnosing and suggesting, but that is about it. My experience with the closest PM Clinic (over an hours drive) was one of the worse experiences I have ever encountered. However a PM Clinic almost 3 hours away was more comprehensive and understanding. It all depends on your state and of course the clinics.

I don't know if there is another state like WI but I don't often hear from ppl in the Dakotas, New Mexico, Wyoming and other rural states. I am just guessing that those states may be similar to Wisconsin.

In my opinion it is better when your PCP treats their CP patients. They know their patients best and the doctor/patient relationship is easier to build. But that's just my opinion. I am sure there are many others that would disagree. 

My PCP does everything she can to keep me as comfortable as possible. We have a great relationship. She trusts me and visea versa. I would be lost without her caring and concern. 

So I would agree with you. I am sorry that you are labeled. I cannot understand why some physicians do not understand CP and others do. I encourage you to look for a physician that understands your pain and how best to control it. Remember that we hire these physicians to provide a service. If they are not delivering the service that we expect it may be time to move on. Be assertive, I don't mean aggressive and take control of your health care.

I wish you the very best and look forward to your updates.

Take Care,
~Tuck