What is a Pain Management Specialist?

Hi everyone!
I was just wondering what exactly will a pain specialist do for me. Has anyone been to one? I am now 8 months post-op (laproscopic hysterectomy). I have had terrible abdominal pain and swelling since (swelling in abdomen and legs/ankles). I spend at least 50% of my time in bed, 40% of my time reclined in a chair and the other 10% slowly moving around. I am on perkocet and naproxen. I have had x-rays, 2 CT scans, cystogram, ultrasound and nothing shows up. I have had 2 urine tests and blood work as well and all shows fine. I can't walk well, lift anything, bend or go to work. My insurance company cut me off months ago because nothing is showing on any tests. I have been to my Family DR on several occasions, been to a urologist (b/c I pee all day long) - nothing wrong with me though, and to my oncologist (surgeon) 4 times. I am being referred to another specialist - a pain specialist. I can't seem to find much on the web so I was hoping that someone could share their experiences with me if they had gone to see one. I heard from one of my family members that they do a psych evaluation of me to see if I'm 'making up' the pain. This may be kind of fitting for me b/c my surgeon thinks that I am making up this pain. I am sooooo frustrated! But as I told him today, I don't think that I could make my belly swell up so much that people question if I'm pregnant! My Doctor has referred me to a GYN (female) to see if she could help me. I told my Oncologist today about this and he seemed offended and said that he was going to send me to a pain specialist to see if they could help. He has never offered help in the past let alone suggest anything.
Sorry about the lengthy post - I just wanted to give a quick history of what's going on.
It would be great if anyone could share their experiences with me.
Take Care!
Angels Love

Ok I Was Kinda In The Same Boat As You..did You Have Everything Removed..i Didnt I Had My Uterus And My Left tube Removed In Nov Last Year.pain Never Went Away So I Went Back And Forth With My Ob/gyn For A Few Months Then For Some Reason She Did A Internal U/s And Didnt See Much Except My RIGHT Ovary Had A Few Baby Cyst And My Tube Had Fluid But Said That Wasnt Making All My Pain Couldnt Really See My Left Ovary It Was Attached To My Vaginal Wall..so She Said She Wanted To Go Ahead And Send Me Back To The Or To Remove My Ovaries And My Right Tube..well When She Cut Me Open And Went To Get My Left Ovary She Found A Hernia What A Surprise That Was.I WONDER IF THAT IS WHY I LOOKED PREGNANT .now I Am Going On 4 Weeks Post Op And Feeling Much Better So Far I Am Glad We Did What We Did Now If I Just Stay Pain Free I Will Be So Happy..good Luck Keep Me Posted On What Happens..LAST SURGERY WAS JULY 18 2008

Thanks for the reply. I had everything removed except my ovaries, I even had the top part of my vagina removed as a precaution. Ultrasound & CT scans show nothing like cysts on my ovaries. Also everything seems to be in the correct position. They checked me today for hernia - I don't have one (so they say) I guess the GYN that I'm being sent to is pretty well known - good thing on my part. I did some research on her on the computer and she sounds like this is who I should of gone to the first time. When I told my oncologist today that I was going to see her he was quite surprised. I told my oncologist that she may do a laproscopy of my abdomen to see if I have any adhesions. From what I know, adhesions are scar tissue on the inside usually caused by surgery or trama to a certain area. I also know that adhesions do not show up on any imaging tests like CT scans, ultrasound or x-rays. My oncologist looked surprised that I knew this and said that if my GYN decides to look in my belly with a laprascope that he would want to be present with my GYN when she performs it. Does this sound weird to anyone that he would want to be with my GYN when she does this?

The feeling I get most of the time is like when you put rubbing alcohol on a huge cut - it burns sooo bad, it almost feels like my stomach is ripping open. Sometimes it feels as if I just came out of surgery with fresh wounds. Sometimes it feels like a hot stabbing pain and sometimes it feels like the worst charlie horse ever. All of the different types of pain that I described comes out of nowhere. I will be just sitting there and BAM! I'm in pain... When I cough it feels as if my belly button and vagina are attached. Strange feeling I must say....and very painful too! Sex is obsolete. None prior to surgery b/c of pain and bleeding and definatly none after surgery. My poor DH!
I told my oncologist about hystersisters and how a few of the women on the site are experiencing similar if not exact pain as I feel and he said that it was very unlikely that I am feeling how I feel. I am so ****** with him.
Anyways, sorry to write so much again. I'm just super frustrated.
Thanks for your response!

Hi Angels Love,

First off I want to say my heart goes out to you! I am so sorry you are suffering so much ... it just isn't fair. How you manage to keep your chin up is beyond me.

My gyne was going to refer me to a Pain Management Specialist. It is my undertanding that a PM Specialist is an aneathetist who specialized in dealing with pain whereby physical symptoms cannot be found. I was told that my nerves endings in my spine may be short firing. I am sorry but that is as much as I have to share with you.

Please don't take it personally when the doc says you may need a psych evaluation. This is not uncommon for them to do when the doc can't figure out a physical reason for your pain.

My suggestion would be to go from doctor to doctor until you find someone who HEARS you and HELPS you.

Great big hug,
Tracy (Newmarket, ON)

There is nothing more frustrating than KNOWING something is wrong and being in pain and the Doctors telling you they can't find anything. Let me give you my story.
I had a Laproscopic Vaginally Assisted hysterectomy on January 23, 2008. I did keep my ovaries but she took my cervix. After the surgery and reduction of pain meds I noticed the previous pain started to reappear. I went back to the surgeon and she told me there wasn’t anything more she could do for me. She recommended I see a GP. I did. He decided to run a battery of tests on me. To date I have had pelvic and back x-rays, complete blood work up, pelvic and abdominal ultrasounds, a colonoscopy, and pelvic and abdominal CAT scans.
The colonscopy showed that I had diverticulitis. My GP sent me to a surgeon. He ordered a Barium Enema. When he got the results, it showed that my bile was twisted causing the problems with my colon. He felt that my bile was twisted due to pelvic scar tissue. He wanted to do surgery to correct the problem.
When I went back to schedule the surgery he told me that he changed his mind. He said the fact that my “body functions” were working fine he really didn’t want to take a chance of causing more problems with scar tissue. He also said that the diverticulits was not very bad at all and didn’t feel as though that was the source of my pain. He recommended I see a Gynecologist again because he felt the problems I was experiencing was in that area.
I didn’t want to return to the surgeon that did my hysterectomy. I went to Magee’s Women’s hospital in Pittsburgh Pa. in July. I saw a new Gynecologist there and went over my history with her. She did another ultrasound and found a cyst on my left ovary. She put me back on YAZ and wants to see me in October for a follow up.
I’m not a Doctor and don’t try to pretend that I know anything about medicine but I do know my body. I have done more research on the Internet than you can ever imagine. I “think” my pain is caused by adhesions from my c-sections. I have mentioned this to every one of the Doctors that has treated me. They each tell me that that could be a possibility but adhesions really aren’t treatable and since they are reoccurring it’s not the best path to take.
Each Doctor has prescribed pain medicine for me. I hate taking pain meds, but I do get a few hours relief each day after I take them. At the present time I have a prescription for Ultra set. I only take one dose of it a day. I don’t want to get addicted to pain meds and I surely don’t want my body to get use to them and then have them not work. It is the only relief I get! I am about to run out and the thought of having no pain relief at all makes me crazy. Each Doctor wants me to see “someone else” for the pain medicine.
I am truly at wits end.
Through Histersisters I got in touch with a women that gave me another option to try. She put my in touch with

<Oops! Please don't post doctor names/website addresses on the message boards per the site Guidelines.>

I have an an appointment with him the end of this month. I am saying my prayers that he may be able to help me. He may be able to help you as well. Good Luck with everything.

I've been seeing a pain management specialist for years for a separate condition, but he also worked closely with my gyno for my hysterectomy so that my other condition didn't flare up.

A pain specialist (PS) is basically just that- they care for all types of patients with all types of pain, whether its something you can see or something you can't.

I have a neurological condition called Complex Regional Pain Syndrome, its similar in a way to MS etc. There's no cure or effective treatment, all you can do is "manage" the pain with a range of techniques and medications, but these are different for everyone so its a constant battle to stay on top of my symptoms.

PS's are up to date with all the different pain relief options, whether its medications, drug infusions, surgeries, procedures, physio, psych techniques etc, and will often work with a team to give you the best treatment- ie, I see:

My PS Doctor: who oversees my whole treatment and prescribes my medications and treatments etc,

A Pain Psych: to talk about how this all affects me in a counselling way, but she also teaches me how to use different techniques to help cope with the pain and manage the pain, such as distraction, heat, relaxation, meditation, etc

and their Physio team: who understand that "no pain, no gain" is often NOT the answer, and they help you regain and keep your mobility and movement, no matter what your condition is.

The best thing about Pain Specialists is they BELIEVE you have the pain, even if they can't see it.

Just to have that acknowledged is a wonderful thing! Then they'll do what they can to work out if they can get rid of the cause of the pain (if possible) and help you improve your life.

You do usually have to fill in a few questionnaires at the first appointment, which usually ask things like: where the pain is, what the pain is like (ie stabbing, sharp, throbbing, burning etc), how you'd rate it out of 10 on a good day, and the same for on a bad day etc. It'll ask you what treatments you've had, what medications you are on and have previously been on, etc etc, just to give them an idea of where you're at. It will probably have a psych part to it as well, as depression symptoms nearly always come with longterm chronic pain. You can't live with pain 24/7 for month after month without getting depressed by it!

But the depression that comes with pain isn't always due to the circumstances, though. For instance, my condition affects the nerve signals going to my brain and how my brain interprets them, and so my nerves send depression signals as well and its just part of the whole condition at a neurological level.

So just because you may have symptoms of depression, it doesn't mean they'll assume you're making the whole thing up and that there's something mentally wrong with you, its to evaluate how your whole body is working as one and what they need to look at helping you with.

I've probably rambled on a bit here, but I just wanted to give you an idea of what to expect, from someone who has lived this life on a daily basis for the past 8 years!

Take care, I hope they can get to the bottom of this and you can start improving and getting your life back.

xx

Also just to add to my last post-

You don't necessarily have to go down the opioid medication route when it comes to pain management. I'm on a medication that calms down the nerve signals going to my brain and it works wonders for the constant burning pain I get. It's not addictive and its not in the narcotic class at all. There are also muscle relaxants and other types of meds that can help with pain without being addictive.

Anti-depressants can be great for pain. And taken correctly (even with the narcotic based pain meds) you don't get addicted to them. Your body gets "used" to them and you would get a reaction if you suddenly stopped taking them, but that's the same for blood pressure or epilepsy or diabetes medication. There's a difference between you being addicted to a medication and being dependant on one.

Narcotic meds don't get you high if taken correctly for pain. That's what they were created for- not for people to abuse, but to give genuine pain sufferers, pain relief.

So just keep your mind open in terms of all aspects of pain management. Ask lots of questions so that you are happy with whats suggested. I'm no Doctor of course, but over the past 8 years I've tried a wide variety of medications and treatments for pain relief, and I've spent countless hours researching all the various pain relief options, so if you have any more questions feel free to ask!

Thank you sooooo much 'overthis already'and 'menoherone'! You have given me some hope and encouragement to help me get through this. I feel just as frustrated as you guys are. The Dr's I've seen seem to want to shove me out of the door except my GP. The surgeon said the same about possible adhesions but passed the idea off. Because they are scar tissue, there is a really good chance that they will grow back after cutting them. Well, I say 'let's take that chance, b/c I can't handle this anymore!'. Even if they were cut and grew back at least I would have a month or two without pain. I probably would walk everyday, do a cartwheel or two, ride a roller coaster and slip down a slide.
I also do agree that depression is part of chronic pain. Some days I feel terrible and cry a lot - it takes everything I got to get through another day. Some days (very few) I actually feel good. Both my GP and surgeon thought that I had tried to commit suicide because I had a cat scratch on my wrist. (thanks kitty!) I would never, ever do that to myself. My pain meds and muscle relaxants seem to be taking some of the pain away, but b/c not one single test has shown any physical issues, my insurance company thinks that I can return to work. I talked with my insurance company today and explained to them that my work does have a return to work program but is very limited as to how they could assist me in returning. I told them that one of my colleges had a health issue some time ago and had to be away from work. Work of course wants you back and convinced him to return on modified duties. He returned to work, passed out 2 times in 2 weeks and it was only then that my work decided that he wasn't ready to return to work yet. Anyways, he died last year. He should of never came back to work. I said that I didn't want to be that statistic.
I am actually very excited to see this Pain Management Specialist now. Of course, now that I have been filled in a little bit about what they do. Do you think that they could give a decision about what is wrong with me on the first day that I visit them? I would imagine that I would go to see them quite a bit. Maybe once a week or once a month?
Thanks again princesses! I hope that you feel better soon and that we all get some relief.
Lots of Hugs!
angels love

If you see a pain management doctor, make sure you go to a facility that is full service. Some are basically pill pushers and might do a few nerves blocks. You need a place that does extensive testing to see where the pain is coming from. My daughter has had chronic pain for many years and she was finally diagnosed with adhesions in her upper abdomen. She has a spinal stimulator which is control most of the pain with out narcotics.