What can i expect at first visit to pain mangt center?

Discussion in 'Fibromyalgia Main Forum' started by nje, Sep 14, 2005.

  1. nje

    nje New Member

    i posted a few weeks ago about my dr. sending me to a pain management center. i got some good feedback from it. i just need to know a couple more things. i`m on percocet 10/325,2 -four times a day.my dr. gave me enough until my appt which is friday. do they cross-examine you like a drug addict? what sort of questions will they ask? i just want to know how you`re treated in those places.somebody whose been and knows all about it please respond as i don`t like changes to well;but can adjust better if i know what to expect. hugs to all who suffer(((((((((((all of us)))))))
  2. nje

    nje New Member

  3. LollieBoo

    LollieBoo New Member

    I am eager to hear a response as well- I was just referred to a PMC, and I'm worried because I feel like I've been labled a problem patient or a drug-seeker, and like I just am hypersensitive and can't tolerate pain.
    I have a very high pain threshold, and have dealt with much pain from acute illnesses, injuries and childbirth (3 times!). I can handle that pain very well and have always taken a very moderate route with medications when I've needed them.
    The difference here is the intensity of the pain at times, coupled with the inability to function for sometimes months and the loss of all focus and cognitive skills with no way to "make it better." Labor was going to end, and I knew it- I would heal from my wounds, I could assure myself of that in everything else... but with FM, there is no end in sight.
    I stayed optimistic for a while- even when struck with an excruciating, debilitating headache that maintained an unbearable level of intensity for 6 weeks straight. When it briefly subsided, then returned was when I finally decided to try medication. With every one of my symptoms, I first try to deal with it non-medicinally, however if I am going to be managing this condition for the rest of my life, I am going to need help! And when it flares, I will need to be rescued. My hope is that that is the focus of the PMC. But I am worried, because of all of the remarks, referrals to psychologists, and negative attitudes that I've seen expressed towards people with chronic pain.
    Gosh, I always ramble on in here- is that poor ettiquette? I'm sorry!

    But I am excited to hear the answer to your post, so please, if you know- tell us!!
  4. nje

    nje New Member

  5. nje

    nje New Member

  6. Zzzsharn

    Zzzsharn New Member

    My firt appt with my pain specialist was over 2 hours long, with a complete medical history and physcial exam. I had to sign that I would only use 1 pharmacy... that if it was found I was using different ones, I would be removed as a patient.

    Pain doctors know the difference between drug seekers and people who are actually suffering with pain. Don't fear.

    Write down all the prescriptions you have taken in the last year- and the names of the doctors that prescribed them. If you have time, get your medical records from your current primary physican and anyone else you have seen for your fibro. Drop them off before your appt. The more information you hand them the better able they are to prescribe a medication that can help you.

    Write down your biggest concerns with the fibro.. like, Unable to sleep,difficulty with memory,fatigue...and of course pain.

    The better prepared you are- the more YOU will get out of the appoinment.

    Good Luck!
  7. ilovecats94

    ilovecats94 New Member

    I went to a pain specialist and he didn't not believe in any pain meds and he didn't believe in FMS. All I got from him was that I had to lose weight. He took me off the Prozac that was helping me and put me on various other meds. None of the meds helped me, only made me worse.

    The trip to see him was over an hour round trip. I drove myself after hubby went with me twice to show me how to get there.

    Another member from Virginia was thinking of seeing this same doctor until I posted about him and mentioned his name and address.

    All he did was at my request, start me on Xanax, then he ended up firing me because I wouldn't come there 3 x a week to get biofeedback. I had to end up going to my family doc to get refills for the Xanax, because this man left me without any refills on this med after I had been on it for 9 months.

    His name is:
    Craig Pinsker MD PhD
    9211 Forest Hill Avenue
    Richmond, VA 23235

    Thought I had his phone number, but I don't. The third med that helped me was Diclofenac along with Cytotec 200 mcg.

    NJE, I hope your experience with pain management is better than mine was.

    Good luck today!

  8. LollieBoo

    LollieBoo New Member

    Okay, so I want to see Sharon's doc and am thankful that I don't live in VA! I'm still nervous, although resolute. I want to hear more. Anyone else?
  9. justlooking

    justlooking New Member

    I'm sorry no one replied and you got upset.

    In my experience every pain management clinic and Dr is different. I've been to ones where they don't believe in medication and want their patients to go into expensive therapies, like biofeedback, physical therapy, injections into the areas of pain, etc. I believe this works for some people and some types of pain. However it did nothing for me and left me feeling like they didn't take me seriously and at the time I was going to these places because of a serious headache disorder, not FM.

    I also went to one that provided a comprehensive treatment plan. They did allergy testing, tried different medications and therapies. I felt at the beginning I was making some progress but after awhile I felt the same and went back to my PCP who was more willing to work with me as opposed to me having to do everything the pain clinic wanted, even though it wasn't helpful.

    I am now going to a pain clinic who is very sympathetic to all types of pain, including FM. They do believe in the use of pain medication but they do suggest other types of therapies, but if you don't want to do them, they don't force you. They have offered massage therapy, injections and different types of medication. Over the past 10 yearsm I've been through it all and tried practically every medication available and at this point I'm unwilling to be a guinea pig and they accept that. My PCP found this clinic and he works closely with them and they have been willing to accomodate his recommendations for me because he has been my PCP for 10 years.

    So far I've not been met with much Dr ego, they have been great for me and since they work with my PCP, I feel like I'm taken seriously and listened to.

    I'll be honest, because of my past experience, I was reluctant and very nervous about going there, but so far it has been ok. My thought was, I'll give it a try and if I'm not happy, my PCP and I will find someone who is right. My PCP is getting close to retirement and has begun to find his long term patients alternate medical care and I appreciate his help and recommendations. I would suggest if you have a PCP who you trust and respect ask them to assist you in finding the right Dr for you. I know my Dr had a conversation with the pain clinic before I even went there and I believe that helped establish that I wasn't a drug seeker or hypochondriac. I know I've seen horror stories on this site about some pain clinics who assume the worst with new patients.

    Anyway hope I helped some!


    Oh yeah, on my first visit they mostly asked questions about my medical history and did a short exam. I also had to fill out tons of paperwork. Since they had spoken to my PCP prior to my appt they had my medical file sent to them from my PCP, all 10 years of medical notes....

    So many of their questions were based on what they had read in my history but also how I was feeling currently and what treatments I felt had been helpful in the past and what types of Drs besides my PCP had I seen.

    They also said they would support my SSDI, which I had won just a couple of months before my first appt. You always need to make sure (if you are on SSDI or plan to apply or currently in the process) that a Dr will support it, because if they won't you may get denied or at the review period they may not send the information you need to continue your benefits.

    [This Message was Edited on 09/15/2005]
  10. tngirl

    tngirl New Member

    My pain management specialist is also a physiatrist (physical medicine specialist).

    The first visit, a complete medical history and a complete exam. Tested muscle strength and also joints, asked alot of questions about my pain.

    I was referred for physical therapy and also given ultracet and baclofen (a muscle relaxer).

    The initial visit was because I have degenerative disc and facets and arthritis spurs. He ended up diagnosing me with fibromyalgia and now checks my tender points each visit.
    He has also prescribed a tens unit.

    He has since upped my pain medication to ultram with vicodin for more severe pain, and robaxin (muscle relaxer) and cymbalta.

  11. justlooking

    justlooking New Member

    Hoping you will see this before your appt today.

    I know you were upset about the lack of response (based on another post you made on this subject)!!!

    I hope you've seen this and know there are some responses here :)

  12. ckk

    ckk New Member

    hello! my first visit was basically a talk about my background of arthrits, at the time i didnt even know i had fibro, he found that out for me thru tests. he asked me what my neurologist had given me and i told him ultram so he asked how that worked for me, i said good and he prescribed it. then more pain, found out about fibro etc and now he also gives me vicodan. doctors just "know" who is looking for pills and who isn't. if you are they can tell. they can tell by tests and feel the swelling etc. on your body to tell how much pain you are in. so i wouldnt worry if i were you. good luck.
  13. orachel

    orachel New Member

    And NJE...thanks so much for this post. I've really been wanting info on this, and now it's a really time sensitive issue for me, so perfect timing!

    I see my FM doc Monday to discuss extreme pain issues. I'm on ultram and zanaflex, but still regularly have pain in the 7-9 range (where 10 means off to ER) while RESTING, let alone trying to do anything.

    So here are my questions...would love any input. Thanks in advance!!!!

    1) How did you first get your doc (or approach your doc) about sending you to pain management clinic?

    I like my doc, but its a new relationship and rapport isn't really there yet. I've already called him and tried to expl that while ultram and zanaflex may get more effective over time, and I know that, I'm in almost unbearable levels of pain very frequently, and its taking its toll. He gave me an appt 3 weeks before I was scheduled to see him again (that's this coming Monday), but I know he doesn't believe in narcotics, or anything stronger than what I'm on. I'm already going to take him MULTIPLE articles from other doctors/studies abt how true ADDICTION is impossible as long as you take acceptable amts for your pain level, don't take when not needed, and never exceed dosage (dependence is different matter, clearly). But I really think I need a referral to a pain clinic, as I know he's not going to scrip me anything stronger than what I'm on. I don't want to change docs, but how do I get him to send me to a pain clinic in the 1st place?

    2nd...When you're choosing a pain clinic, what is the accepted way to find out (preferably on phone before 1st appt) whether they're one of the clinics that NEVER use pain meds and only alternative therapies, or if they'll consider pain meds if your situation warrants it? I'm not sure how to ask that, and I DO NOT WANT TO COME OFF LOOKING LIKE A DRUG SEEKER! I'm not...I keep hoping the ultram and zanaflex "kick in" like doc says they will, and I'm already doing Aquatic Physical therapy, and have an appt with a pain mgmt psychologist who specializes in biofeedback on Tuesday. I'm reading everything I can get my hands on, switching to all natural diet, researching supplement plans in a big way, and practicing deep breathing/meditation/ and visualization techniques to try anything to deal with this pain without over medicating. IT'S JUST NOT WORKING! I know it will work in the future, I know I can get well, but seriously...I'm ready to lose it with this pain. I'm usually on the couch rocking and sobbing silently by the time my husband gets home in the evening, just because the pain has been awful all day, all night, and it gets worse as the day goes on. Plus, I'm taking klonopin for sleep, which is great for my restless leg, but I'm still waking up 5-15 times every single night! No wonder I'm hurting, but I just can't bear it anymore, and I really don't think I should have to suffer THIS badly every single day, nonstop.

    I didn't mean this to become a pity party...I'm so sorry, but I just almost can't stand it anymore. Plus, its really nearly killing my husband emotionally to watch me like that in the evenings, and that is so not fair to him. He desperately wants to "fix" me (he's an engineer...go figure! lol) and is so sad because theres nothing he can do.

    Does ANYBODY have any advice on these issues? I know this is totally too long...sorry. I'm just sitting here now with tears rolling down my face because I can't stand the physical pain....It's really making me a little bit nutso!Please? Anyone have any ideas?

    Thanks, and Gentlest hugs...
  14. orachel

    orachel New Member

    If you have a few minutes, please answer my questions directly above? Sorry its so long, but its really just 2 questions abt your experience. I guess this is really just a selfish "bump"...but I'm kinda desperate here!

  15. LollieBoo

    LollieBoo New Member

    I still haven't been yet (next Thurs. I go to PMC), but as far as #1: I called my drs office every time the pain became unbearable and explained that I had taken my meds as prescribed, continued exercising/stretching, using TENS machine, etc- basically detailing everything I had done to attempt to derail my pain or deal with it on my own, and assured them that I was being patient, waiting for long-term meds to eventually scale-down overall pain, but that when I experienced a flare-up, I needed something to help me through so that I could stay on track with my other therapies. My drs office then finally got sick of hearing from me (ha!) and suggested a referral to the PMC/ Physical Medicine. Doing it that way took a while, but they were able to see the cycles of pain, and I'm sure could tell a difference in me from times when I felt ok, to times when I could barely pick up the phone.
    As well-spoken and educated as you appear to be, I don't think you should hesitate to ask your dr up front if a PMC might be the most appropriate way of dealing with your pain.
    If you approach your doc at the next appt about pain mgmt alternatives, and he/she(sory- I didn't pay attention!) is not willing to approach it in a way that makes you reassured and confident that the worst of your pain will respond to dr's ideas, say so. Say that you do not have confidence that that course of action will bring you long-term relief and ask for another option. If still no resolution, say "Do you feel that it would be more appropriate for me to be seen by a pain management specialist?" That is what I think I would have done, if it hadn't worked out the way it did.

    I know that you will follow through with your determination and resolve, and that you will get to a good PMC, however it happens- Good Luck, God Bless and I'm hoping that someone with actual experience posts their answers to BOTH of your ?s.

    BTW- I'm "nutso" too, so you are not alone!
  16. orachel

    orachel New Member

    ... Are currently stewing in my brain! That is so funny. I guess if you ask enough, eventually they'll send ya just to get rid of you, huh? What a riot.

    Thanks so much for responding, btw...I don't know why, but when I wrote that I was just a WRECK for like an hour...Um, maybe because it was right before time for another one (or 2!) of these mostly useless ultram pain meds?! I guess that's it.

    And as for you're compliments about me being well-spoken...that's pretty darn funny. Go read the post I just wrote to you in Lavada's post on depression, and you'll see what I mean. But thanks!!! Makes me feel a lil less foggy and wacked...And good to know I'm not the only occasional nutball rolling around these boards!