Pain doctor appointment coming up

[susiestar]

I have my appointment with a pain doctor on Monday. I am terrified. I have heard such horrible stories about people being cut off of services for all kinds of things, even things that are not true.

I am praying that the docs will help me. I really NEED them too. I also NEED results from the endocrinologist about the labs that were done a MONTH ago.

If anyone has been to a pain management doctor, can you let me know what they do? It seems like such an undefined area of study. So many things can cause pain, how do they know what to do?

Also, I know they have contracts that say you can only use one pharmacy and only they can prescribe ANY medication for you. Can you get them to agree to let your other docs prescribe for their specialties?

I have the endocrin doctor dealing with a very specialized problem. I cannot see how a pain doctor would be qualified to do the prescribing for this. And if they call the endocrin doctor to get the info and then do the prescribing, well, it makes me nervous. Seems like a game of telephone - so how would I know if it is truly what the first doctor wanted? And what if I have a sinus infection or something and can't wait months to get in? Can I still go to my primary care doctor for antibiotics or allegra or whatever?

I also have heard of people being accused of not taking their medications because they had a stomach bug or a 2 or 3 day migraine and threw everything up for a couple of days. I know that would throw pill counts off. As often as I have migraines, etc... it is really worrying me. i would hate to get started and then be thrown out because I had a migraine.

ARe the agreements just that you won't get pain medications from any other doctor? because that was NOT what I was given to sign when I had the epidural shot. I wouldn't sign it then because I was only having the doctor do that one thing and didn't plan on seeing him again. This appointment is with a different doctor because I REFUSED to see the other doctor. he was just too AWFUL and his staff just didn't give a rip.

I am in terrible pain because my doctor had increased one pain medication and then I ended up running out because I was taking the medication 2 times as much as when he first prescribed it, so it only lasted half as long (the increase was at the doctor's direction). But the nurse was confused and it took a week to get her to agree to take my fax to the doctor. So I have been out of medications for a week new and it will be another week to get them in. So going to the appointment will be very difficult.

Thanks for any info. I am becoming a wreck about this, as you can tell. Anxiety is VERY high. Luckily my blood pressure is not up much.

Hugs to anyone who made it through all of this.

Susie

 

[Marguerite]

I can't speak for how it works in your area, but what works for us with our pain management specialist, is he oversews the pain medications in general. It's a bit like having a really good GP keeping all the connections active with all specialists, plus having someone on board who is authorised to prescribe the stronger medications.

We don't have exclusive agreements, but some medications are only permitted with the overseeing approval of a pain specialist. Some of my medications, some of husband's medications, can only be prescribed by a GP for a limited time, unless they get specialist authorisation. Our health care system in Australia monitors prescriptions as well as authorisations, it all joins the dots. Therefore for us, a pain specialist makes it all much better.

Before I saw a pain specialist, I was very limited on what medications i was able to get. I could only get one packet at a time, which would last me three days. I was seeing my GP twice a week at least, sometimes more. And my pain was NOT well-controlled. So I asked my GP to refer me for pain management. It was a bit confronting at first because I have to see my specialist at a hospice for terminal patients. But so very soon, I was able to have my medications reassessed and overhauled, so what I was put on was not only more effective, it was also healthier for me.

So after the involvement of the pain specialist - he writes to my GP, who is then on much stronger ground when it comes to writing my pain medications prescriptions. If the government asks sticky questions, she has letters she can point to, paperwork she has filled in with the pain specialist's signature on it, that says I am allowed to have these medications at this dosage. And I feel safer knowing I can get a month's pills at a time, and will not have to argue with anyone for it. So I'm less inclined to try to doctor-shop or stockpile.

There can often be a lot more restrictions on availability, when you move to stronger pain medications. There are sound reasons for this because people can and do abuse these. Not just patients, but some doctors abuse it. So if you do find restrictions, they could well be for these reasons. Hopefully there will be a trade-ff in terms of better overall pain management and supervision of your treatment where it involves medications related to pain. As far as other medications are concerned - if they have an impact on pain, but are prescribed by a different specialist, then your pain specialist needs to know about them as part of your overall package but is unlikely to interfere with them in our system, at least. For example, the rheumatologist hasput me on prednisone. This also has analgesic benefit. My pain specialist knew I was seeing the rheumatologist (he asked me to go see him) and is getting copes of all letters from him. The pain bloke also knew that prednisone worked and by now, will have a letter from the rheumatologist about this. They may even get their heads together to see if they can come up with some medication alternatives, to get me off the prednisone but still have a similar action on the inflammatory process this indicates (previously not identified). What these two specialists are cooking up, is at the fringe of my GP's capability. My GP is very good, but is a generalist, not a specialist (of course). In this, she defers to those with more expertise.

What you want with your medical care, is a concerted, cooperative effort coordinated by one member of the team (usually the GP). Some areas require a specialist to be more capable of thinking outside the square and also of being able to overlap into other specialties. Pain management is one such area.

I hope there is no blanket rule that a pain specialsit takes control of ALL medications. Or if there is, then I hope he will automatically re-prescribe medications not connected to pain management, previously prescribed by another specialist. That would also be common sense.

But where a pain specialist takes control of prescription of all pain medications - this is generally for very good reasons. Ours take control but do it perhaps in a different way. husband gets his pain medication prescriptions from our pain specialist, while my GP writes my scripts (with the specialist's authority). So even one specialist in our case does things differently for different circumstances.

Susie, when you are in pain and you've found medications that help, it is understandable to be anxious for fear of supply running out. If there is a system tat works well with a pain specialist, and if you are only taking the medications as directed, you should be MORE carefully managed and be LESS likely to find yourself running short.

I hate the fear of running short. I'm permitted to occasionally take extra and I tell my specialist when I do. But it does mean that over time, I sometimes find myself in danger of running out. I can generally do something about it before it gets that far, but I can relate to the anxiety.

What helps best, in terms of good relationship with your doctors (especially pain specialist, pharmacist and GP) is continuity and transparency. I do my utmost to stay with the same one and I keep my prescriptions with the same pharmacist. Where most patients take repeat prescriptions home, or drop in on anybody, I try to give all the work to one person. It also means he shows the same loyalty to me when I need more medications - I just make a phone call.

Hopefully someone with more specific local info will give you the answers you need, as to how the paperwork functions in your neck of the woods.

Marg

 

[crazymama30]

I'm hoping maybe Janet will chime in, as I believe she has seen a pain doctor in the past. husband sees a pain doctor regularly. He is not on a contract, tho I know many pt's are. Here the contract is used if the pt is going thru medications too quickly, or if they are suspected of abusing them. Not a problem here (knock on wood). husband's pain doctor writes scrips for a muscle relaxer, percocets, and celebrex. He also does steroid shots, and x-ray guided injections of some sort, and has also done several nerve ablations.

Yes, at least here you still go to your primary doctor for antibiotics, allergy medications or whatever. husband's psychiatrist does all of his psychiatric medications. If husband gets sick he goes to see our primary doctor, or a doctor in a box--whoever is available. Our primary doctor has not prescribed pain medications for husband in years. Not since pain doctor took over. We use the same pharmacy all the time, but for me it is a safety issue. husband takes a lot of medications, and using one pharmacy can help prevent interactions. I try to make sure to send a current medication list with husband to all md appts, I keep an updated one in my computer and just print it off as needed.


Basically how it works for us is pain doctor treats pain. Only pain. Now with husband, if he gets really sick his pain gets worse. I have taken him to the ER before when he was ill because his pain is so out of control, but that has only happened twice in the last 3 yrs. Here the pain doctor has access to the hospital records, so he can go see if husband has been going there a lot. Not sure about the other clinics though.

I hope your pain doctor is as helpful as husband's has been. He was the first person to actually believe that husband's pain was not just in his head. Had a rheumatologist tell him that.

 

[Hound dog]

((((hugs)))) for your anxiety. Perfectly understandable.

Hopefully Janet will see your post, or you could pm her and ask.

Keeping body parts crossed all goes well.

 

[DammitJanet]

I dont go to a pain management doctor. My family practice doctor is the one who prescribes my pain pills. I am on a pain contract with them though. Or I assume I still am because I signed it just prior to going in the hospital last fall and I obviously had copious amounts of medications prescribed by other doctors during my hospitalization.

As far as what I was told my pain contract meant....it meant that I couldnt doctor shop for pain medications in basic terms. It was perfectly fine for me to get my psychiatric medications from my psychiatrist and to get other medications from other doctors...ie doctor in the box if needed...but I just couldnt go to several ER's and get extra pain pills cause I wanted them or go to another county and go to another doctor and get pain pills. I also had to only use one pharmacy. Ok...no problem. I use one pharmacy and it is a national chain should I ever be out of state and have a problem.

 

[Star*]

Susiestar -

Sadly DF sees a pain management doctor every month and has for the last 5 years or so for his Methadone (which we discussed in PM). If you ask DF (who is also not NOT a touchy feely guy) which of his doctors had a broken giveadamn it would be the pain management doctor. So I hope from our point of view you don't expect too much. I have a pet name for this doctor - it's not nice, and I can't say it around my Mother or she would wash my mouth out with soap.

I hope that when you go - you get some answers - BUT GO WITH A SHEET OF QUESTIONS - and make him answer your questions - try to keep it to a list of 10 - THAT seems to help my doctor - but he's also one of those 60 second men - in, out, last time I had to remind him to wash his hands - but then he never touched me.

I know you are in pain, I know you are scared and I know you need answers so I'll keep praying for that.

Hugs
Star

 

[susiestar]

Thanks all. I am working on a list of questions. i will try to keep it to 10.

I now, as of Jan 1, MUST use the mail order pharmacy. I can use the local pharmacy, but the pricing is vastly more expensive. (Guess who owns the ONE mail order pharmacy I must use?? You got it - the insurance company!!!) But for antibiotics and anything that I can't wait 2-3 weeks to start, I have a local pharmacy. I am thinking of a switch to WalMart because the national thing and the pricing. My insurance co charges more than 3 times as much for prozac as WM does for the 3 mo supply).

So, while I hate having more than 1 pharmacy, it is necessary. I just don't know if they will understand.

I am going to stay OFF of the chronic pain support boards. They are FULL of horror stories and I just can't handle them now.

 

[Hound dog]

I am going to stay OFF of the chronic pain support boards. They are FULL of horror stories and I just can't handle them now.

Good idea.

Hugs

 

[crazymama30]

I agree with Daisy. I bet there are some horrific stories. Hugs, and I hope your pain doctor is a good one. There are good and bad of all people.

 

[DammitJanet]

Doctors do understand insurance and pharmacy's. I could use a mail order if I wanted to...I could get my "use all the time, monthly scripts" through my AARP or I could get them through the CVS mail order. I choose not to. Its all the same price for me because of the type of insurance I am on. If there was a difference I would have to figure it out. My doctors would have to adjust to this.

What they are trying to do is track things. They arent attempting to cost you money.