My fabulous Rheumy (who saved my life last year, recognizing peritonitis and checking me inot the hospital when OB/GYN's nurse told me to go home- burst small intestine, major surgery, YUK) and who treated me like a human being, retired, and had to send me to a physIatrist for pain management. First visit: REALLY upsetting. Says he wants to get me off as many drugs as possible, then wants to prescribe 2 new ones and change another. Doesn't listen when I tell him my concerns about Lyrica (Neurontin worked great, but caused bad headaches.) Wanted me to take the Lyrica for at least 10 days, even if it gave me a headache. So you want me to have a headache for 10 days?? No thanks. Wanted me to go to Neurologist to see if there's any nice new preventive meds. (But I thought we want me on fewer meds???) Neurologist and I have tried every class of preventive except MAOI, and I'm not going there. Topamax made me suicidal. No thanks. Also, physical therapy. Pool therapy, 2-3 times a week. OK, sounds good. On the script is written 'Gentle reconditioning and Desentisization". Can you really desensitize someone with fibro?? Found a good, understanding PT whose wife has fibro, and knows what's what. Great. But the closest WARM pool is 45 minutes drive from here, and my insurance doesn't cover ANY physical therapy. Doc prescribes 3 oxycontin per day, instead of the 4 that I have been on. And makes the interval longer than 30 days because I tell him that I do not ALWAYS need 4 per day, only with fibro flare or migraine, so I have a few left over at the end of the average month. Oops. So: I figure, probably I will arouse the suspicion and possibly wrath of DEA if I get another new doc right away. MAJOR stress ensues. I try the Lyrica and it upsets my stomach so much that at the end of 4 days, I have missed my final concert of the summer and I call my Dad to arrange that he takes me to the hospital for another bowel obstruction. (I pass gas finally after a night of agony, about 16 hours after my last dose of Lyrica. Hallelujah, no impending abdominal surgery!) OK, so now I am really upset about this pain doc. I proceed to do what he asks. I see my neurologist, who agrees with me that I am better off without additonal drugs. I write up a history of every drug I took for migraine prevention, for how long and why I discontinued. Never less than 6 week trial was given, only one thing at a time was ever changed so the neuro knew what was causing improvement or problems. Neuro phoned pain doctor regarding my visit. I gave the 3 pages of info to the pain doc. This info includes the non-drug therapies which work, including avoidance of caffeine, MSG, etc, as well as describing my method of dealing with a bad headache. (Go to bed with meditation CD, take phenergan to sleep. Take pain meds only if needed.) On the end of the note is a message to call me, or have his nurse call me, so I know he got the note. No phone call. It is now a week short of a 30 day refill, and 10 days short of my next appointment. If I do not get any migraines in the next week (unlikely) or have no fibro pain (hahahaha), I can stretch to 30 days. Otherwise, I will be REALLY hurting either from not taking pain meds, or withdrawal because I run out. (You will notice that I did not get any meds for 'breakthrough' pain.) I call the doctor and talk with his nurse, explaining that I have no recourse in the event of migraine or fibro flare, and I don't understand why I don't have adequate meds for breakthrough pain. I am outwardly calm, although I am SOO afraid of the doc deciding that those who want a refill before the official date must be abusing their meds, and put me in detox for abusing pain meds. The nurse says, the doc will have to talk with you. Two days later, he does. I explain again, and he seems to actually be getting the gist of my problem, and schedules me to come in two days later. Second appointment: is this the same doc???? He listens. He actually DID read the note I sent. He writes a reasonable refill, allowing for breakthrough pain, having established that I really DO have knowledge about my migraine situation. I can't take anything short-acting, including Percocet, for a migraine because of rebound headaches, so he agrees that taking an extra oxycontin on a migraine day is appropriate. Before, I think he thought that I was using too much oxy, and inappropriately, even though I had the same explanation. Moral of the story: any doc, especially a pain doc, will be inherantly suspicious of liars and abusers when you first see them, wanting a script for pain meds of any kind. You do what they ask and they will 1)begin to believe your sincerity or 2)never listen anyway because they just want you off pain meds. I was lucky to be referred to a guy who began listening. I am chalking the first visit up to a bad day, and hope that things continue to work out.