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975514 tn?1325001538

When to Move On To Another Doctor?

I suffer from DDD, mild scoliosis, degenerative facet disease, bilateral facet arthritis, sciatica, and I have minor nerve damage which has caused my left foot and part of my leg to go numb. My foot is always numb. The numbness creeps up into my leg if my facet arthritis is not kept well under control or the swelling is really bad in my lower back. It's the worst when I sit. I also have a shoulder problem and had a surgery in 2008 which has left my shoulder in constant pain.

Anyhow, through many MRIs and a failed shoulder surgery I ended up in a pain management clinic. I didn't like how I was treated. I didn't like how the doctors treated me like a number, wanted to stick me with needles and seemed to want to get me hooked on narcotics (even if I needed them to feel ok). I weaned myself off of the small amount of Vicodins I was taking, and I ended up finding a great PT who referred me to a Rheumatologist who diagnosed me with Fibromyalgia back in Oct. '08.

We tried several different non-narcotic meds with some success and I've been 65% happy with my treatment, but I have felt somewhat uncomfortable with my diagnosis because I kind of don't think I fit all of the Fibromyalgia criteria. I am not depressed. I am fairly stable at work. I don't have insomnia. I do have trouble sleeping if my shoulder is acting up or if my back is swollen, but other than that I am ok with sleeping. There are other things too.

Trust is really important to me when it comes to my relationship with my doctor. Last time I visited her in April I asked for a small script of Vicodins and she gave them to me. I was surprised! If she would have said no, I would have accepted that and moved on, but I felt proud that I thought she trusted that I would be responsible with them. I came to realize that sometimes my pain does get so bad that I do need to take something stronger than my daily anti-seizure meds. I don't think the neurosurgeon would have sent me to pain management in the first place if he didn't think so. But anyhow, I made the script last twice as long as she wrote it for [(3) 5/500 per day, but I never took that many some days none] and when I called in for a refill, my doctor downgraded the medication to Darvocet without even telling me, or having her assistant call me.

When I called the office to find out why she changed my meds, my doctor's assistant told me that "they are not a pain management clinic and if that is what I am looking for I may need to go elsewhere." Obviously this woman had no tact, but I was horribly disappointed, hurt and humiliated. I would have never even bothered with asking for narcotics in the first place if I knew what kind of mess it would cause to get a refill- especially when I have plenty left and I was told to fax in my refill request early because their office was super busy for the summer. I have also asked the doctor a few months earlier if I should be referred back to pain management because I have to get steroid injections in my spine a couple times a year and she can't do them, and the doc said NO.

So now that I have spilled my guts to you all...does it seem like I am better off in pain management? I am wondering if my spinal problems are too big for a Rhuematologist???



9 Responses
356518 tn?1322267242
Hi and I am so sorry you were treated so rudely. I do believe you would benefit much more from pain management. PM does offer more than other doctors in Pm and also they tend to understand your pain issues much better too.
I would definitely get a PM doctor.
I would also talk to the doctor who treated you so badly and make it very clear that you were treated badly and that there was absolutely no reason at all for it. Remind her that you asked if you should go back to PM and tell her that you were offered narcotics in the past and you refused them but you have reached a pain level that is just not managed with the current meds your on and that you resent being treated as if you were drug seeking.
I applaud you for trying to stay at the lowest levels of narcotics and I am sure you do not want to take them but your pain requires you to from time to time. Please understand that you have pain and it needs to be treated no matter what type of medications you need to do so. The stigma that comes along with taking narcotic pain medications is hard to deal with at times but do not let that stop you from getting the treatment you need and deserve to have.
I have stayed at the lowest possible level myself and have suffered alot of pain to do so . I have finally realized that the medications are doing no good if I do not take them as prescribed and have started taking them like my doctor suggest. I would take only half of the dosed allowed to me to keep my level down and suffering.
I have a new PM doctor and he has told me to take them as he prescribed and the full amount and see how I am doing in a month. It has been only a week or so and I am doing so much better and plan to continue to take the full dose.
I urge you to see a PM doctor and take the medications as prescribed and see for yourself how much better you are. Pain is a disease and has to be treated as such. A diabetic would not alter their insulin to stay on the lowest does possible as it would hinder their treatment and the same goes for pain management.
I hope you will keep us updated and we are all here for you even if you just need to talk or even vent. We all do here and it helps:)
547368 tn?1440545385
Hello fellow Wisconsinite,

I am sorry to hear about your increased pain and the rude manner that your PCP treated you. I am a bit puzzled however and can only guess that PM may be different in Milwaukee than it is in the rest of our state. My PM is provided by my PCP. When I had an extensive evaluation at the PM Clinic they made recommendations (and performed treatments) but did not prescribe narcotics. My PCP handles all my PM.

At any rate if you are not obtaining the respect and understanding that you deserve from your PCP it may be time to find another. Remember physicians are service providers and we pay dearly for their service. They work for us and they do not treat us out of the goodness of their hearts. I do not mean to imply that many aren't kind and wonderful, my PCP certainly is but she still provides a service for me.

I too applaud you that you attempt to keep your use at a minimum. You deserve to be comfortable and as pain free as medically possible. If you must return to a PMP to obtain treatment for CP than by all means do so.  I just do not understand the statement of your PCP "assistant." If you have been happy with your PCP up to this point you may want to make an appointment and speak to your him/her directly. Sometimes things can get changed in translation. The "assistant" may be using their own words and not your PCP's. Darvocet is considered less potent or equal to IB, even though IB is not a narcotic.

I don't think she can refuse a referral, even in an HMO situation, if that is what you require to see your previous PMP and manage your pain.  I hope you will keep in touch with us and let us know how you are doing. I will look forward to your updates with interest. Best of luck to you.

Take Care,
Tuck


975514 tn?1325001538
I need some advice!!!

I was able to talk to the other medical assistant about the Vicodin issue. She said that I wasn't raising any red flags with the doctor because I've always followed instructions, but they were trying to back me off the Vicodin to see if I'd respond to something less potent than Vicodin. That is why they were trying the Darvocet. I can't believe they think my pain is that small???

BUT I was an idiot and desperate and decided to ask my Rheumy for a script of Tramadol even though I've tried it before and had horrible headaches and anxiety from it. I told the assistant that the Darvocet didn't work and that I decided to try an old script that I had of it and it seemed to help a little. Of course my doctor had no problem giving me a script of it instead of the Vicodin.

Well, the first night I didn't sleep- I had the jitters. The next two days I was in horrible PAIN, and had the WORST migraines in the world. PLUS I was SOOOO tired. I almost fell asleep at the wheel on my way to work AND on my way home from work. I decided NOT to take anymore and I am back to square one.

I dont' want to call them back again because I feel like a complete moron after all that's gone on. As I mentioned before, I do have a half bottle of Vicodins left, which normally would be plenty to get me through to my early Oct. appt. since I don't take a lot, but since I was worried about being cut off I was going to save them. I think I am just going to use them, leave my doctor alone and just let her know what happened when I meet with her in Oct. and cross my fingers that she will write me another script.

I mean she only gave me 2 scripts of (90) 5/500 to last for 6 months. That's not a lot. Is it?

Also, I went to see my PCP doctor last Tuesday. She is worried about my nerve dysfunction problem and now she is sending me for a CT scan in addition to the MRI I already have. She wants to find out if they can locate my compressed nerve, so that maybe they can dig it out and take away my numb foot and leg. I guess that would mean back surgery. I am a little scared. My shoulder surgery didn't go too well. I can't imagine back surgery would be any easier. Anyhow, Thanks for listening to my very long post.
356518 tn?1322267242
You need to speak directly to your doctor to let her know whats going on.Sometimes messages to her may get mis- translated.
Tell her what you have been through as far as not getting any pain relief and I am sure she will work with you to find something that will.
if she is uncomfortable writing the medications you need then see a PM doctor, and I believe you will get much better results as far as options.
547368 tn?1440545385
I agree with Sandee. Call your physician and explain what has happened. (However in our state PMP do not generally prescribe narcotics nor treat CP patients long term.) I am sorry you are going through these hoops. You should not have to suffer with this pain.

So you have a half of bottle left of the Vicodin on the first refill or the second? When did you originally get the script? At any rate I would take one now and speak to the prescribing physician.

No, 90 tablets with 1 refill over that time frame is not very much. In our state your PCP can prescribe for you but don't get into 2 different physicians prescribing narcotics. That will raise red flags. If you have a good relationship with your PCP than speak to him/her and explain what you are going through. Ask her advice if your prescribing physician is not willing to help you with pain releif.  Indeed in our area it is the PCP that prescribes and not the specialist.

Sorry I haven't a lot of time right now. I will check back with you later.

Take Care,
Tuck
975514 tn?1325001538
Thanks for your responses to the both of you. I have been very careful and have let my PCP know that I will only allow my Rheumatologist to prescribe pain medications at this point despite the fact that I am not completely pleased with the level of my pain relief. Just to clarify, my Rheumy wrote my Vicodin script back in April for 90 plus one refill. I am using the last half of the second bottle now. I don't think I've been abusing them, but I have come to the realization that nothing touches my pain but narcotics and it bothers me because of the stigma and also the difficulty in convincing doctors to treat with them.

I've have tried just about EVERYTHING. I am worried about getting pushed into another surgery. Or forced to take some crazy antidepressant that will cause me to become mentally unstable because I really don't need it. Right now I am working full time, and I am the main breadwinner- my husband recently lost his job due to the economy, so it's even more important that I am able to function.

I am currently taking Topamax and it's helping to ward off migraines but that's where the relief ends. I've tried every NSAID out there and developed an eye problem from Diclofenac (in June 09), which is too bad because it was the only one that didn't cause me stomach problems or migraines. Now because of my NSAID intolerance, I can't keep my osteoarthritis under control and I have extreme pain in my shoulder and in my lower back. It's extremely frustrating.

I think it's time to go back to a pain management doctor I just don't know who I can trust. I am really worried about it.
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