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Advice about seeing a Pain Management Specialist Advice about seeing a Pain Management Specialist

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Unread 02-24-2009, 11:16 AM
Advice about seeing a Pain Management Specialist

Hi, I go to see a pain management specialist on thursday as per the uro-gynecologist suggestion. He feels I have developed a chronic pain syndrome and that I would benefit from pain management to help resolve things.

I did see a PM doctor in Dec before the hyster and he kept asking me what I was looking for from him. I told him I was seeking ways to control the pain prior to surgery and explained that percocet and motrin wasn't working and the pain was steadily increasing. He wanted to know what I thought he could do for me? I really did not know. I still do not know.

I want to make the most of my visit to the new doctor on Thursday. I'm confused by the previous visit and need advice on what is realistic expectations for my visit.
How should I best prepare.
Any questions I should be asking?

Does anyone have previous experience in PM for CPP?
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Unread 02-25-2009, 01:34 AM
Advice about seeing a Pain Management Specialist

Doctors who are helping patients with pain management issues try to be very cautious. Often the patients are going to be prescribed medications that they may need to take continuously for a very long time and a physician wants to be very sure the pros outweigh the cons.

For me, my doctor wanted specifics vs. generalizations. He wanted me to be able to tell him exactly where I hurt, what the pain felt like (burning, pulling, tearing, sharp, etc.), what made the pain worse/better, what options had I tried, how was my life be affected, etc. He was not going to prescribe medications, especially narcotics, unless he thoroughly understand what I was going through so he could decide what meds would be best.

I would suggest writing down all of your symptoms in a journal. Be as detailed as possible. You might want to see if ReliefInsite’s online pain diary would be helpful. Note exactly where your pain is and how it is affecting you. Does the pain radiate to different areas? What makes it worse/better? What activities increase/decrease your symptoms? Are you better at certain times of the day? Does eating change anything? So on and so forth. Also, make a list of all of your current medications and supplements with dosages along with how effective they may or may not be. Be sure to note who prescribes each medication and his/her field.

Plan to ask the pain management specialist if there is any treatment available besides using pain medications. I often was referred to physical therapy and also found massage beneficial (my issues were different than yours). Acupuncture, Bio-feed back, TENS unit, relaxation exercises, and much more could possibly be used on conjunction with any pain medications given.

You are also going to want to let the doctor know what your goal is. Do you want to be pain free or just reach a tolerable level of pain? My doctor knew that though I would prefer pain free, I was willing to live in some pain and avoid stronger medications whenever I could.

Unfortunately, there has been a lot of abuse of medications so doctors who deal with pain management have to be very careful. A doctor has to be able to know you are definitely experiencing pain that necessitates pain medications, especially those that can be addictive. Thus, you want to be able to be very clear about what you are experiencing and open to the help offered by the physician even if it is different than what you were expecting i.e. physical therapy rather than a prescription. Give it some time to let your doctor get to know you as pain management can be a long term relationship. Initially my doctor didn't give me as many meds. As he got to know me better he could often decide by looking at me what we needed to do--change meds, up meds, physical therapy, combination, give it more time, tell me to get some extra sleep, etc.

Also, I have found it very helpful to take my spouse with me to appointments as he could share examples of how my pain was affecting me, give examples indicating I am experiencing specific pain, share what has been or not been working, and he was able to discuss varies options and verify what medications I was taking and how often. He provided a type of checks and balance for both me and my physicians--I knew I had someone on my side to help me remember stuff and share details and the doctors knew I was not in the battle alone and hey could verify information with my spouse to ensure I was getting the help I needed.

I wish you all the best and hope this helps! S
Unread 02-25-2009, 07:18 AM
Advice about seeing a Pain Management Specialist

Thank you Weiser for that detailed response.

As far as preparing for the visit I have already prepared a list of all my doctors and their specialties as well as requested they send records to the PM doctor. I have drafted a time line of when I saw the doctors and what was done and the results including medication, tests, surgeries. I also am almost finished writing a narrative of what has brought me to this point.
At this point I find discussing all of this to be redundant and I do not want to leave out something pertinent just because I've already said it 10x's.

I was wondering how the visit will go. Will I have a physical exam? Do they ever perform any tests or treatments? Any idea of how often I'll go back?

I'm familiar with PM from an orthopedic/neuro perspective. But I can't show him what hurts. In addition the pain is multilayered. The only thing I can tell him is these are a different pain than before the hysterectomy.(at least I think so).

Before my hysterectomy I did see a PM doctor but when I left him I had the impression he did not treat gyn/pelvic pain often.On my own I scheduled an appointment with a pelvic floor therapist about a month before the hysterectomy but the pain became so bad I couldn't go. My cuff still isn't healed so I will need to wait a few more weeks before I go.

My goals for PM are I would assume the same as many others. I would like to be able to return to my prior level of function. (before the endo/adno and cyst). To do that I will not be able to be on narcotic pain medication. The pain needs to be managed well enough that those around me will not be able to tell i am in pain - at all. I will need to be able to tolerate 10-12 hours on my feet performing physical activities, (bend, reach, on/off floor, lifting ect.) multitasking and critical thinking with few breaks if any. It will also have to subside to the point it is not overwhelming my thoughts and interfering with my ability to concentrate.

Is this specific enough? I feel like I'm running out of options and I need to make the most of any resources I have in order to get better.

Thanks to all for advice and support
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Unread 02-25-2009, 12:16 PM
Advice about seeing a Pain Management Specialist

It is more difficult to describe pelvic pain issues! Using drawings or pictures might be helpful.

It sounds like you have made a good start and hopefully your appointment will go well. A physical exam will depend entirely on the physician so I cannot say what will happen. I would suggest being prepared in case there is one. How often you visit will also depend on the physician, what treatment plan is set up for you, whether or not you are sent for testing, if pelvic floor therapy is involved, what medications might be given, etc.

If you can specifically give details of what your pain was like prior to your hysterectomy and how it is different now, this could help your doctor determine was is going on. You may also want to ask if the PM doctor would like your records and narrative in advance to read prior to your appointment. I have had instances where a doctor/NP has read my information prior to an appointment and times were the info was not read until the appointment.

Since you have experience with a pain management for different issues, use your experience as a guide to get you started.

Take care!
Unread 02-25-2009, 01:13 PM
Advice about seeing a Pain Management Specialist

Thanks, I did not mean I had personal experience with pain management. Just experience from others who have gone. Thanks for the advice
Unread 02-25-2009, 08:01 PM
Advice about seeing a Pain Management Specialist

I just started seeing a pain specialist last week, and can definitely say it was the right thing to do. My background includes PID, polycystic ovaries then a TAH/BSO in October. My gyno thought for sure it would resolve all the pain issues I was having, and while it did for some of it, some new pain cropped up and was severe enough that I was in pain daily. My internist didn't know what to do to help, other than saying stay away from pain management. My gyno saw me several times post-op, then finally told me to see a pain specialist he had found. I was pretty scared about the whole thing, as my internist had specifically said not to do it, but I was getting no answers from anyone about why I was still in pain.

The pain specialist I am seeing sent me a packet with information, along with about 25 pages I had to fill out about specifics regarding my pain, my complete medical history and all meds I was currently on. I had to go back to my gyno and internist and get all past Xrays and CT scans, both the reports and the actual films. (Because he had all the test results, he was able to really help me right off the bat) I got them all together, and saw him last week. He spent about an hour with me, going over all my past history and what I wanted to get out of this. I did have to sign a contract stating I would let them drug test me at will, and that I wouldn't get meds from other doctors while he was treating me.

It turns out he is a specialist in pelvic pain, and thought that part of my problem was the pudendal nerve. He then set me up to have an outpatient nerve injection done on Tuesday. I had it done, and while I can clearly say that my butt is still sore from the injections, it does seem to have helped a bit. This first set of injections was just a diagnostic, to see if it helps...there are more permanent things he can do if that nerve is causing the problem. I can get more detailed if anyone wants to know more - it really was no big deal, other than the fact that sitting isn't going to be comfortable for a few days.

My point in all of this is that I had two doctors I trusted who really couldn't do much for me, and were bordering on not believing me about how much the pain was affecting my daily life. I still haven't been looked at for things like endo, so I probably skipped a few steps in the diagnostic chain, but I went with what help I was being given and it has the potential to help. Finding the pain specialist was awesome because he not only believed me, but he could offer me solutions I had never heard of or read about. He did prescribe me painkillers (just hydrocodone - he will not prescribe anything stronger) but his main thing is finding the solution to the problem. He emphasized if this doesn't fix it, there is still a ton more that can be done, including sending me to be checked for endo, so not to give up hope. I was really despondent over this whole mess, until I found this guy, so I hope you have the same luck as I did!
Unread 02-25-2009, 09:21 PM
Advice about seeing a Pain Management Specialist

Thank you for sharing your experience. I wish they had sent me a package to fill out prior to the visit. I'm so beyond tired of seeing doctors and explaining the past year. When I explain my complaints and what most of the doctors have done, I feel like I'm bad mouthing them by saying they never found anything wrong and said it was in my head.
I hope tomorrow goes well, I just do not have a lot of confidence right now. The pain has worsened in the past few days and it has become very difficult to think positive. Thanks again
Unread 02-26-2009, 06:44 AM
Advice about seeing a Pain Management Specialist

I know how you feel Hope, and even though I was so very angry at being shuffled around, I tried to keep a handle on it and let the pain specialist see the situation for itself. He'd ask me what works for me, and what dosage, and I'd be completely honest about how I was taking the meds and how much it improved my quality of life.

The funny thing is, I got all those test results, and found out both of my other doctors had been fibbing about results to me. I still can't get over that, even though I've found help.

Let me know how you make out - I'll be thinking about you today!
Unread 02-26-2009, 01:00 PM
Advice about seeing a Pain Management Specialist

Well, I'm back from seeing the PM doctor. I realized when I got there I forgot to bring the summary I wrote. Then they told me they received NO records from the doctors that I requested. I call one the referring doctors office and they finally sent them over.
The staff was nice and doctor seemed interested in helping me. He said seeing my pain is fairly new he sees no reason why it will not resolve in time. He feels with medication I should feel pretty good and return to prior level of activities including work in the near future. Resolution may take from 3-12 months maybe longer but he doesn't think so.
He prescribed a pain patch, neurontin and low dose percocet for break through pain. He says once I get the right combination with neurontin and patch I shouldn't need anything else.
I hope so

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