Pain doctor appointment today

[DammitJanet]

I had my doctor appointment today about my back. He said that there definitely looks like there is something wrong with the lumbar region. Ya think? LOL

I told him all my symptoms and he felt around and I whimpered appropriately I guess and he tried to get me to bend and I couldnt and all that good jazz. We went over why I was asking for the CT instead of the MRI and he just looked at me like I was nuts but I stood my ground. They are scheduling the CT.

One thing that really irked me thought, they wanted to do some procedure where they insert a nerve block into my spine before they even do the CT. I said no. I mean hello? We dont know what is wrong with my spine, what if they go in and hit something they shouldnt that they would know about after the CT? nah. I dont know that I am gonna let them do any procedures anyway. They did one earlier and it didnt work and in fact made me hurt worse. I may take the CT scans to my ortho and see what he thinks.

Plus the docs put me on MORE pain medications! They kept me on my long acting morning and night medications but added two doses of fast release 15 mg morphine to use during the day as needed. Good lord above...if I take all that, I wont be awake!

 

[InsaneCdn]

Good gravy boats!
Next thing you know, somebody else will need to do a "drug test" on you and you'll end up being charged for being a drug addict!!! <not quite, but...>

While you're going through the process... thre used to be something called a "pain cocktail" - and it doesn't have a specific make-up... its a custom-built thing. Some of the teaching hospitals here have it - where they find the combination of painkillers that is effective for YOUR pain - allowing for interactions etc. Often works better than straight morphine, because there is more than one kind of pain going on.

 

[DammitJanet]

I do get drug tested...about 4 times a year...lol.

I dont know if you saw the list I posted on someone elses post about what I take but I do take a cocktail of medications...about 4 for psychiatric, 5 for regular health stuff and 3 or so for pain.

 

[InsaneCdn]

No - the "pain cocktail" will be ONE medication - usually a liquid - which is compounded based on a number of pain medications in different proportions. It replaces the stack of pain pills.... it would NOT reduce the other stack of pills! But for pain - my aunt had this - it was way more effective than combining pills.

 

[DammitJanet]

Ahhhh...hmmm...that sounds interesting. My pharmacy does compounding.

 

[InsaneCdn]

The pharmacy can't do the "tweaking" - pain doctor has to.
But ask the pharmacy if they know about this stuff... and who in your area specializes is prescribing it.

My aunt had severe RA plus several other conditions... and then got meningitus, and the only thing that worked for pain and didn't make the other symptoms worse.

The key to this stuff is that they can move any one ingredient in small increments. I don't know pain medication compounds very well, but here's the stimulant equivalent in logic...

Concerta comes in 18mg increments. 18, 36, 54... and then combinations of that. Fine, if the 18 mg increment lands about where you need it.... but for many kids, 36 is not enough and 54 is too much... With Ritalin tabs, they can be split down to 5 mg... which is a much finer dose (but you don't get the delivery mechanism...)

With a liquid pain cocktail... they can have a combo going, and then go "+1mg of morphine and -.5mg of something else"... this is what makes it possible to "tune" it to your needs.

 

[Mattsmom277]

I'm glad you're getting some testing but sorry about the reason. Pain is the worst and trying to control it can drive a person crazy. The compounding thing sounds very interesting! Meanwhile, although using the new combination of medications daily may put you out (so to speak), there may be days its needed. If its a horrible day, just make your bed comfy, keep needed items close at hand, and make it a couch or bed day and allow the medications to offer relief. Hope the testing offers some new answers for you.

 

[susiestar]

Insane, don't even THINK about that. It is NOT unheard of in the US. There is a man in a FL prison with a long sentence for drug use because he used drugs his pain doctor gave him the way the pain doctor prescribed them. Yes. As nuts as it sounds, the DEA in that area is nuts. They told the doctor that if he didn't say the man stole the rx pad (for just those 2 rx's each month - they have serial numbers like checks on them so if you took a whole pad it would be easy to see) and forged them, then the doctor would also do many years in prison. So the doctor testified that the patient misused things. The doctor OPENLY told prosecutors that he was LYING about the defendant, but they told him if he even hinted of that in court then they would put him in prison for drug charges and they put him on the stand KNOWING he lied. So the man, who was something of an activist trying to get the US to see that while addiction is a problem, there are a lot of people who have a legitimate need for pain medications and that pain medications are not something to demonize.

The man got a LONG prison term, decades. I haven't heard if he is out yet, though one governor refused to pardon him and the appeals that I know of were either denied or totally ignored. One of the FIRST things that the prison system did for this man was to implant a pump to put morphine and muscle relaxers straight into his spine!! He was such a druggie who has NO real medical problems that he was sent to jail (he had been wheelchair bound from painful spinal problems for years before the trial), so the prosecution claimed and the jury believed, but the prison, the place he was sent to punish him, gave him far more of the medications than he was ever accused of!!!!

This is NOT a lie, not an urban myth, I don't know the names at this point but I have looked up the court proceedings because I couldn't believe it when I read about it. This is how crazy pain mgmt is n the US. Heck, I know people who are refused care because they had two pills short when they took the medications to the doctor = most pain docs make you take your medications in to be counted at each appointment so they can see if you have the right number of medications left.

Janet, I know you hate MRi's. I also know why a CT scan might be more help. in my opinion you need both to have the full picture. I am totally behind you on not letting them put stuff in there until they know what is going on. I hate that it means you are in pain longer though. There are quite a few schools of thought about the shots for spinal problems. Most use a steroid combo and lidocaine. Not sure what you have read on line about them, but take it with a big shaker of salt if you do much online research. Remember, those it helped usually are out living their lives rather than posting on web boards because most boards don't build family the way we do here. My mom has spinal stenosis and the shots help her greatly. Or did until this last few months when things got worse.

Much as you HATE MRI's because the claustrophobia, if you actually want them to be able to see all that they need to see, then you need a closed MRI. Not the open one - it gives an image that is far lower in quality. You need to insist that they either sedate you (usually a dose of versed or something simlar) or else they anesthetize you. They may say they can't. That is bs. They tried a sedated MRI with Jess and it just wasn't going to happen. The movements wouldn't stop. I told them ahead of time, but what does mom know? So we had to go back and they gave her propofol, a very short acting anesthesia that let them actually put her under. It has more risks, this is true. And for most things is inappropriate.

Given your problems and your claustrophobia, it is a very appropriate solution, in my opinion.

Sweetie, take the pain medications. For a week or so you will sleep most of the time. So make sure that there are easy to eat and drink things by the bed. And then sleep. What is it that you have to be away for, anyway? Going to a job? Nagging Billiy? cleaning the lint out of your belly button? Your body will take a week or two to adjust and then it will learn to cope with the medications and the medications will help you not hurt and help you cope and n Occupational Therapist (OT) make you seelp all day. Until then, sweet dreams. Tis far better to sleep than to sit there whith every move hurting so bad!

 

[InsaneCdn]

Susiestar... this is one of the times that I'm glad I'm Canadian. Our system is not quite so paranoid about this stuff. I've never heard of having pain medications "counted" at medications review time. Not ever. Now, we're not on anything extreme - but even my Mom and my Aunt - who both were severe RA and on mega put-you-to-Pluto pain medications - never had to do that. Straight morphine, maybe they'd be really careful about, but in general they have to know the patient before well before they can script that one.

 

[DammitJanet]

I never wanted to be put on morphine but they now have these stupid pain management clinics because the DEA got all over our family doctors when they were prescribing for their regular patients that they had known forever. I suppose that there were bad doctors who did over prescribe. I have been on pain medications for years now but they have been at different levels and different medications. First starting out with a really mild one...darvocet which isnt even on the market anymore. I tried ultram which I quickly learned I am allergic to. Or maybe allergic isnt quite the term..horrible reaction...I throw it up immediately. I hated being on so many of the medications which had tylenol added in to them...taking them as needed or 3 times a day per script. I was on vicodin for several years 3 times a day as needed and I cant stand taking that much tylenol into my body...I think it will kill you faster than anything else. Heck they have just lowered the OD level on that again.

As soon as my old family doctor stopped practicing full time at his old office, I switched to the office his dtr worked at because she had seen me once or twice and I had hoped that he could vouch for my character...but she refused to prescribe pain medications and sent me off to the pain doctor.

Now normally I am pretty happy with them with me. I usually see this older doctor who has been really great but once in a while I see the younger guy I saw today and I dont like him as much, he is more pill happy. I have told them from the get go that I dont like the pills. I wanted to be on the lowest amount possible. In fact, I started on the 15 mgs and the older guy made me go up to the 30s because he saw me walking and said I simply couldnt be getting enough relief. I agreed to give it a shot if he assured me I wouldnt feel funny. I dont like the fact that they seem to be pushing procedures. I also dont like some of the clientele I see in the waiting room and the conversations I have overheard but that isnt my business. I know what I think but maybe I am making assumptions that are not correct.

 

[Mattsmom277]

Hijacking a bit here, Insane, there are serious issues with prescription pain medications in our province. We have some doctors in town here handing them out like candy on Halloween with zero medical cause. We have others that due to those abusing them through other doctors, will not prescribe at all for pain regardless of the issue. ER's will never give more than a day or two of pain medications under only strict reasons, and that leaves over 10K of us here without a doctor with zero options in spite of painful medical conditions.
Pain clinics here do indeed do random calls to patients to bring their current medications in for counting, same day as you get the call. They count to be sure you have the right amount left for the prescription period. They also call for random drug tests to make sure you aren't combining your script with other medications bought on the street, or that you are actually taking your own medications, not just getting hte scripts and selling them.
Pharmacies here now write your name down just for over the counter tylenol 1. Also any pain medications must be ordered a day ahead for refill. They keep no pain medications on site any longer. Each day they place the order for the following mornings delivery of just what they need to fill scripts coming due the next day. My nearest pharmacy, a huge chain one, recently began only filling scripts if you provide your ohip number so they can check for double doctoring and using multiple pharmacies.
These are just a few reasons I haven't bothered trying to get help for the chronic pain associated with my MS. I know my quality of life would improve and I might even be able to return to work with some relief. But the ability to even find a doctor to work with you is prohibitive. Last thing I want is a doctor that is pill happy. I know of 2 people locally who died this year, using exactly the dosage and times per day their medications were prescribed. One person was on 4 separate very strong pain medications, all from one doctor, for "some arthritis in her knees and early stage arthritis in her hips". The medications were not the run of the mill ones. She was on the potent ones usually reserved for the most severe cases of pain (think terminal painful cancer etc).

Janet, I hear you about wondering about some of those conversations you over hear. And it leads you to wonder if you've landed at a pill happy doctor. The only upside of a pill happy doctor is when a patient hasn't got addiction issues and is proactive in learning about the various medications. One can then refuse the strong stuff that is OTT from the pill happy doctor and stick with what they are comfortable with.

 

[seriously]

Sorry to hear you are very claustrophobic cause I agree that an MRI is going to show things that a CT cannot.

We avoid CT's as much as possible due to the very high radiation loading. at least equivalent to 500 regular xrays according to my son's doctors.

If you've already had a lot of xrays or CT's you might want to see if you can find a way to handle the MRI procedure. Hypnosis??

 

[DammitJanet]

My x therapist recently got certified to do hypnotherapy and I asked her if she thought she could do it on me to help me stop smoking and she almost doubled over laughing. She said I was probably the last person she could imagine being hypnotized. I dont relax. I dont trust. Thats why the couple of valium dont work on me for the open MRI. My adrenalin kicks in and takes over. I would have to be given at least twilight drugs. I have had numerous xrays and god I have no idea how many CT scans over the years. I think I have probably had at least 5 or 6 in the last 4 years.

 

[DammitJanet]

And I know everyone thinks I am just being some kind of stupid big baby about the MRI but I really do have a reason for being this scared of it. I tried it years ago when I first moved here and some idiot who was running the machine didnt take the time to do what they are supposed to do before they got me ready. I am a large woman...larger now than then. They were supposed to put a ring over my head and body to make sure I would fit through the machine tube and they didnt. I got stuck in the machine. I was terrified while they had to get me out.

Not only was I in that thing and scared and thinking I was dying...but I was humiliated. Never again.

 

[TerryJ2]

So sorry about your crummy and humiliating MRI experience, Janet. Ugh.

I'm thinking your new medication coctail should get you sleeping through the night, at least.

Let us know when you get the CT results. We want to see progress on this thing!

 

[seriously]

Hugs. I expect the CT will show enough for them to make some treatment decisions. That sounds like an awful experience - PTSDish kind of experience.

 

[DammitJanet]

yes and I already carried PTSD due to a violent rape and kidnapping a knife point when I was 18 with my very best girl friend

 

[TerryJ2]

Gosh, I'd forgotten that. Just what you need. Stay strong--I'm sending strength and thinking about you.

 

[susiestar]

Janet, I do NOT in any way, shape or form think you are a big baby about MRI's. Even without the prior bad experience, which someone should have been FIRED for, in my opinion, MRI's are not an easy thing to endure. I have had both kinds, and have help J's feet as she as them after a fall from a horse. I actually have a harder time with the open MRI because it isn't supported on both sides and I am always afraid it will fall and crush me.

If you truly NEED the MRI to be able to save your mobility, there ARE places that have them designed for larger people. It also is NOT uncommon to give general anesthesia during an MRI. Yes, it has risks, but I would think it was appropriate in your situation. They likely will NOT tell you it is common, may even tell you it can't be done or whatever koi. I have an old friend who is a radiology tech and she told me they do it far more than people might thing - because otherwise it can be very very hard for someone to stay still enough for the test.

The loopy feeling from the medications really will go away after a while, but the relief won't. I know you don't like pills, but you don't like pain either, Know what I mean?? So keep bbalancing small increases when the pain is bad with being sensible and NOT going/doing things at least until you have some clue as to what is going on.

You SOOOOOOOOOOO are not a baby about this stuff. Not by a long shot!