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Pain management for chronic and severe TMJ disorder.
I am awaiting surgery on both sides of my TMJ. I have been on bedrest for 4 months. My surgery is scheduled for December. I have been taking hydrocdone 10mg 3-4 times per day as well as 800mg advil. I have recently been prescribed percocet 5mg every 6 hours. This is the only medicine that actually dulls my pain. My condition is chronic and can only be helped with extensive surgery. I have seen numerous specialists in town and out of town. I have tried non surgical treatments for over a year with no results. I have had a bite gaurd (made my the facial pain specialist) for over 8 years. My MRI in June showed that I only had a small sliver of tissue left in my joint space and the doctors said that once I wore through that, it would become much more painful. I now feel like a hammer is driving a nail into my jaw over and over around the clock. I want to have another MRI done asap. I think I have a hairline fracture or something. It feels like bone grinding on bone. I have dealt with this pain for a very long time, but it is so much more intense now and different. It is much sharper and severe. Anyone else had this happen? I have been to the ER several times in the past 6 months and they say that my pain levels "should be thru the roof" and so on. I have been told that my case is so severe that it could fracture at any time. I think it is finally fractured. I am dying here. The percocet dulls it slightly, but the pain gets worse each day. I am also on alprazolam to sleep at night. I can't even sleep with the meds. I am going to call my doctor first thing in the morning to get in right away and get another MRI and another prescription. I know he will not want me to take the strong pain meds for a long period of time, but they are the only thing that works for this level of pain. I do not abuse them and I take them only as instructed. The prescription should have lasted me 11 days, but I actually made it stretch out longer. I am worried that he will think badly of me if I call on Monday to request another rx. I have to have my husband get them for me because I don't drive. Any help or advise would be greatly appreciated. I cannot take the pain any longer. I just don't want my doctor to think I am a bad person for needing additional meds. I am hurting so bad and want to talk to others who are in the same boat.
Hi Again,
Reading your recent post makes me angry too. Angry at the uneducated physicians in pain management, angry at the system and the DEA , angry most at those that have abused and continue to abuse prescription drugs. Those are the ppl primarily responsible for placing CP sufferers in the situation we are now. Your physician may be getting some heat from the DEA and your case may have nothing to do with it. He may just be trying to "rid" his log of as many narcotic cases that he can.
All that said I do beleive that what your physician is doing may be considered patient abandonment. I would certainly bring that up with my next call to your current physician. I would also request all your record and find another PCP. In defense of your physician there are agencies that are looking over all their shoulders. If they suspect they are prescribing too many narcotics they face lose of the licenses to practice medicine.
So my plan would be to obtain those records and locate another PCP. I would also call my surgeons office and explain what has happened to you. They may have some suggestions.
I would be most concern with the comment about your "addiction." This nurse obviously has no clue about CP. Her second comment is probably closer to the truth, they don't know what to do for you. So they are dumping you. Again please search for a new PCP. You may want to search for a new DO. I think they understand pain better than most PCP.
I wish you the very best. Please let us know how you are doing. Hang in there. We are here to support you and listen. Take care, Tuck
Reading your recent post makes me angry too. Angry at the uneducated physicians in pain management, angry at the system and the DEA , angry most at those that have abused and continue to abuse prescription drugs. Those are the ppl primarily responsible for placing CP sufferers in the situation we are now. Your physician may be getting some heat from the DEA and your case may have nothing to do with it. He may just be trying to "rid" his log of as many narcotic cases that he can.
All that said I do beleive that what your physician is doing may be considered patient abandonment. I would certainly bring that up with my next call to your current physician. I would also request all your record and find another PCP. In defense of your physician there are agencies that are looking over all their shoulders. If they suspect they are prescribing too many narcotics they face lose of the licenses to practice medicine.
So my plan would be to obtain those records and locate another PCP. I would also call my surgeons office and explain what has happened to you. They may have some suggestions.
I would be most concern with the comment about your "addiction." This nurse obviously has no clue about CP. Her second comment is probably closer to the truth, they don't know what to do for you. So they are dumping you. Again please search for a new PCP. You may want to search for a new DO. I think they understand pain better than most PCP.
I wish you the very best. Please let us know how you are doing. Hang in there. We are here to support you and listen. Take care, Tuck
Thank you all for your support! I have tried to reach the nurse at the docs office that "dumped" me, and no response for a whole week!! I have left messages every other day regarding my ref. to the pain mgt. doc. The nurse said they would call me early this week, and no call. I have been calling the nurse to see if she even did the ref. and it's an automated system and you can only leave messages for the nurse to call you back. I don't know if they are avoiding me or what. I am pretty upset, as I have been out of meds for some time now, and they were supposed to get me in to pain mgt. marked as "urgent" on the ref. information. I don't get it. Why are they avoiding me?? I also left messages asking for my records to be sent to me, and a medical release form. I need those records for pain mgt. and my surgery consult date at the end of the month. They asked me to bring them. I don't know what to do at this point. I guess I will try again tomorrow! Thank you all for your support and help. I am obviously frustrated and upset. I don't know why they would think that I could just take advil now, when for the last 4-5 months, they agreed I needed pain meds. I understand that there are regulations on docs writing rxs, but I need to get in to see the specialist asap for help if they are not going to help me. I will post any updates if I ever get a live person on the phone! Hope you all are doing well.
TMJpain,
I feel so bad for you. I am sorry this is happening to you. Can you drive? If not do you know someone that could drive you? I would not call this physician anymore except to inform him that you are on your way to his office to obtain a copy of your records and a referral form. I don't know how long it has been since you requested your medical records but it shouldn't take more than a week for them to gather them for mailing. There is no excuse for this excessive tardiness.
I would than take the referral to the physician named on the form along with your films and records and tell then you need to be seen yesterday. And don't take no for an answer. Others will post with additional suggestions that may be more helpful
This, in my opinion is patient neglect. I'm 99% sure there are no laws that would support my belief but I can't help but feel that way. Hang in there. I know there are physicians that will treat you and help with your pain until you are able to have a surgical correction. You just need to actively search for them. Best of luck and I'll be thinking of you. Take Care, Tuck
I feel so bad for you. I am sorry this is happening to you. Can you drive? If not do you know someone that could drive you? I would not call this physician anymore except to inform him that you are on your way to his office to obtain a copy of your records and a referral form. I don't know how long it has been since you requested your medical records but it shouldn't take more than a week for them to gather them for mailing. There is no excuse for this excessive tardiness.
I would than take the referral to the physician named on the form along with your films and records and tell then you need to be seen yesterday. And don't take no for an answer. Others will post with additional suggestions that may be more helpful
This, in my opinion is patient neglect. I'm 99% sure there are no laws that would support my belief but I can't help but feel that way. Hang in there. I know there are physicians that will treat you and help with your pain until you are able to have a surgical correction. You just need to actively search for them. Best of luck and I'll be thinking of you. Take Care, Tuck
I read all your posts, and I'm so sorry. I get some pain in my jaws and my ears from neck problems, and it is horrible! It's the worst, so I can only imagine what you are going through.
I don't know what kind of insurance you have or if you need referrals, but is it possible to start all over with new doctors? Maybe you can call the insurance company and explain about how they are treating you. It can't hurt, I guess. Also, do you have a dentist or oral surgeon or TMJ specialist that you were dealing with who might be able to help or at least write a letter or something.
The system in this country is terrible. And, personally, I don't really trust any doctors. There are so many bad ones and you have to search constantly for a doctor you can depend on who cares about your problems. I am always looking myself for new doctors. It's very frustrating.
I hope you can get some relief. I know it sounds lame, but do ice packs help at all? I use them for everything. It kind of numbs the pain.
I don't know what kind of insurance you have or if you need referrals, but is it possible to start all over with new doctors? Maybe you can call the insurance company and explain about how they are treating you. It can't hurt, I guess. Also, do you have a dentist or oral surgeon or TMJ specialist that you were dealing with who might be able to help or at least write a letter or something.
The system in this country is terrible. And, personally, I don't really trust any doctors. There are so many bad ones and you have to search constantly for a doctor you can depend on who cares about your problems. I am always looking myself for new doctors. It's very frustrating.
I hope you can get some relief. I know it sounds lame, but do ice packs help at all? I use them for everything. It kind of numbs the pain.
Go to the office or have someone drive you! This is pt abandonment and you have rights!
Make them call if they have not already while your there , sit and wait until you have an appointment set and the referral papers in your hand! If you insist they do their jobs they will/ If you have trouble that way just tell them you will see what constitutes pt abandoment in your stae and you will be in touch.
This will get them off their kiester!
Remeber they are working for you. You pay them for a service and if they are not provivding it then you do have legal recourse.
Make them call if they have not already while your there , sit and wait until you have an appointment set and the referral papers in your hand! If you insist they do their jobs they will/ If you have trouble that way just tell them you will see what constitutes pt abandoment in your stae and you will be in touch.
This will get them off their kiester!
Remeber they are working for you. You pay them for a service and if they are not provivding it then you do have legal recourse.
Thank you for your kind and helpful posts! I spoke with my husband about it, and he said if I cannot get them on the phone by Friday morning, that he would call and if needed, go up there. I can't really get him to take me up there because he has been working crazy hours to try to make up for me not working, so he can't miss work. He is scheduled to do site inspections at work tomorrow, so he can't miss.
I do use ice/heat all the time to help a little. I take anti inflammatories around the clock. I try my best to do the jaw excercises that my surgeon wants me to do, but I can barely open my mouth. I have not been able to brush my teeth without pain from the opening! I cannot floss either because it hurts so bad to open my mouth for that long. I am a dental assistant who can't even take care of her teeth! This has gotten way out of hand.
I am scheduled to see the chief of oral surgery at a university hospital in late November. I hope that he will help me. I have already seen dentists, tmj docs, facial pain specialists, oral surgeons, an arthritis specialist, and primary docs. They all state the need for this specific surgery, but the only one who felt comfortable doing it is injured! The other chief of oral surgery I saw a few months ago, told me that I needed the surgery, but that since I am so young, they would not do it at their facility. They said that "this is a teaching hospital, so we cannot train the new surgeons to be agressive with someone your age." I got the copies of all the notes from that visit, and he wrote that I needed the surgery, but that someone else would need to do it, and then they referred me back to the original surgeon who diagnosed me. She is not healing fast from her injury, and they are saying maybe January, but more likely to be Feb. or March before she can come back to work. The new surgeon I am about to see has to verify my health insurance because it is out of network, and after my consult they will submit a pre authorization and it may take up to 8 weeks. I am so frustrated. I am in so much pain and have not worked in a long time. I am now trying to file for unemployment. My boss fired me a couple weeks ago due to my extended medical leave. I have never been fired. I have worked as a dental assistant for over 8 years. I just want to get better and get back my life.
I will bug the heck out of the docs office Friday am, and let ya'll know how it goes. Thanks so much for all of your great advice and comments. I can't wait to see the new surgeon in a couple weeks. I really hope he can help me. It does not look like I will get in to see the pain mgt. doc before the consult with the new surgeon. If they won't even call me back for the ref. information then I don't see how they will ever schedule my appointment. I don't want to go back to the ER. I owe them a lot of money from the last couple times I went too! They just said I need surgery and told me to see my surgeon. They also said they could not call in a surgeon to do the procedure on an emergency basis unless my jaw was actually broken. I am starting to feel like maybe I should just break it myself and then maybe someone will actually care! I won't really do that, but it has crossed my mind! :)
Sorry for the long rant. It feels good to have people to talk to about all this mess. Thanks again for all your help and I will talk to you soon!
I do use ice/heat all the time to help a little. I take anti inflammatories around the clock. I try my best to do the jaw excercises that my surgeon wants me to do, but I can barely open my mouth. I have not been able to brush my teeth without pain from the opening! I cannot floss either because it hurts so bad to open my mouth for that long. I am a dental assistant who can't even take care of her teeth! This has gotten way out of hand.
I am scheduled to see the chief of oral surgery at a university hospital in late November. I hope that he will help me. I have already seen dentists, tmj docs, facial pain specialists, oral surgeons, an arthritis specialist, and primary docs. They all state the need for this specific surgery, but the only one who felt comfortable doing it is injured! The other chief of oral surgery I saw a few months ago, told me that I needed the surgery, but that since I am so young, they would not do it at their facility. They said that "this is a teaching hospital, so we cannot train the new surgeons to be agressive with someone your age." I got the copies of all the notes from that visit, and he wrote that I needed the surgery, but that someone else would need to do it, and then they referred me back to the original surgeon who diagnosed me. She is not healing fast from her injury, and they are saying maybe January, but more likely to be Feb. or March before she can come back to work. The new surgeon I am about to see has to verify my health insurance because it is out of network, and after my consult they will submit a pre authorization and it may take up to 8 weeks. I am so frustrated. I am in so much pain and have not worked in a long time. I am now trying to file for unemployment. My boss fired me a couple weeks ago due to my extended medical leave. I have never been fired. I have worked as a dental assistant for over 8 years. I just want to get better and get back my life.
I will bug the heck out of the docs office Friday am, and let ya'll know how it goes. Thanks so much for all of your great advice and comments. I can't wait to see the new surgeon in a couple weeks. I really hope he can help me. It does not look like I will get in to see the pain mgt. doc before the consult with the new surgeon. If they won't even call me back for the ref. information then I don't see how they will ever schedule my appointment. I don't want to go back to the ER. I owe them a lot of money from the last couple times I went too! They just said I need surgery and told me to see my surgeon. They also said they could not call in a surgeon to do the procedure on an emergency basis unless my jaw was actually broken. I am starting to feel like maybe I should just break it myself and then maybe someone will actually care! I won't really do that, but it has crossed my mind! :)
Sorry for the long rant. It feels good to have people to talk to about all this mess. Thanks again for all your help and I will talk to you soon!
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