Pain clinic

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Pain clinic

Postby Bernadette » Wed Apr 11, 2012 7:37 pm

Hi everyone. I am due for my annual MRI next month and my GP is sending me to a pain clinic. I was on Lyrica for a few months and it suddenly stopped working. I am currently taking Elavil. It seems to work for the burning and tingling, but the pain is ever present. It seems the more I do, the more I hurt. I have heard that these pain clinics tend to push narcotics. Then I heard that narcotics are not helpful with nerve pain. Any words of wisdom before this appointment?
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Re: Pain clinic

Postby karenb » Wed Apr 11, 2012 9:40 pm

Hi Bernadette,

It all depends on what type of "pain clinic" or "pain management practice" it is... some are great, and some are <<<ahem>>> sub-par at best.

As an example - there are three "pain management" physicians in the town where I live.

1. One physician pushes narcotics, won't let radiologists read his MRI films, and does not keep any medical records. His patients are identified by other physicians by the "drugged-out" look on their faces. When I saw him, he ordered at least 3 or 4 major MRI studies, not one was read or evaluated, but he sure pushed me onto 2000 mg of gabapentin plus 6 Vicoprofen (7.5 mg hydrocodone each) really fast. When I submitted a signed medical release, I was told by his staff that my records would be ready in "46 weeks" (it's been 44 weeks, and my records aren't ready yet...).

2. The second physician heads his own multi-disciplinary practice, and is closely associated with a local Physical Therapy practice. He has leased an entire mini-mall, but runs "silo" practices - you see them for pain management, PT, urgent care, or auto accidents, but no combination of those disciplines. Once you're assigned to a "silo", you cannot transfer to or use another "silo".

3. The third physician is a true pain management physician. She has done a number of things that have helped me: (a) reduced the recommended & max doses of Vicoprofen and assumed management of Gabapentin dosage, (b) used Botox injections with a muscle relaxer (Baclofen) to eliminate spasticity, (c) referred me to a Physiatrist when a portion of my pain was determined to be SI-related, and (d) formulated a custom cream to manage my pain without internal/systemic medication. She's cautious and thorough - doesn't play "cowboy" like (1) or over-important like (2).

Needless to say, I left (1), never got in to see (2), and am extremely happy with (3). She has really gotten my pain under control with minimal side effects, and she carefully tracks and monitors everything she prescribes. I've spoken with a number of patients who are extremely happy with her.

I hope you get somebody like Doctor # 3 above - and best wishes for good results!

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Re: Pain clinic

Postby toport20 » Wed Apr 11, 2012 11:03 pm


I totally agree with Karen!

My story started with a wonderful GP who understood and also had chronic pain. She helped me out tremendously, but sadly, she left to move to another state. She worked with me on "lighter" meds such as elavil, flexeril, etc. She would give me these for awhile and review the meds each time till I got them right and slowly worked up the line.

When she left, the new doc wanted nothing, nothing at all to do with prescribing pain meds. So, I went to a cow herding- oh, I mean, pain clinic, LOL. I am about 50/50 with them. While I am on some narcotics, one of my most important meds was Lyrica. Both my GP's office and the pain clinic have been fighting back and forth about prescribing them for 6, YES 6 MONTHS! The pain clinic wanted a letter from the GP saying they were not prescribing these, so I told them and they gladly filled out the paperwork. Well the pain clinic has lost this twice! I've been so fed up with them. Not to try to sway you either way, I know there are the good and the bad.

I just really wish I had my old doctor back..... :( Oh well, wishing you better luck than me!
Pre OP:
SM 3mm C3-L1
Tonsillar Herniation 5mm due to TCS
TCS Surgery TCI 6-6-08
ICT 6-7-08

Post OP: 2011-MRI
CM 8mm
SM C2-C6 9mm

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Re: Pain clinic

Postby tennesseewalker » Fri Apr 13, 2012 2:30 pm

Hi Bernadette. karenb and toport20 said it right...there are the good and the bad PM clinics. And some of the bad are so bad that they're ugly too.

You usually get referred to pain management because your doc can't (or doesn't want to) prescribe the meds you have to take to feel better.

My NS referred me to one of the UGLY clinics. I was treated really bad, and I was just there for a possible SCS. No meds at all. Then my NL referred me to one of the good ones. Actually listened to me and treated me as if I was a real person. Such a big difference. He put in my SCS, and I haven't had to see him since. This SCS has been a Godsend.

I hope you get a good PMD. Fingers crossed...
Genetic CM/SM (me, my son, my twin sister and both of her daughters), RSD of right arm.
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Re: Pain clinic

Postby phyrehawke » Sat Apr 14, 2012 6:51 am

You definitely have to make sure the pain clinic you are getting into is the best one around. Do not settle for less. This is not your average kind of pain, and we are not addicts and shouldn't be treated carelessly. After I fell on the stairs here in March and my pain changed in a wierd and indescribable way, it took nearly a year of hell to get me to a Good pain clinic, and the longer I am there the more my perspective on this changes. I am on a special narcotic...because only two meds work on this particular spinal cord pain problem chemically and the other option was a hallucinogenic opiate anesthetic...ketamine. They usually only like to give it to people in a coma induced state...hmm...think I will take the narcotic! Normally I too would say never but I had hit a point of desperation. We started with a very low dose and worked up to minimal dose that worked on the daily pain...still having acute problems once in awhile but daily life is a huge relief and I and my neurologist are happy with that. For years not much helped and then things got worse. So what do you do? Give up...or go get some help from people who are serious about helping.
YES, some narcotics are glutamate blockers as well as opiates and that makes them extremely effective on certain types of nerve pain and not others. It can be a major relief in such a small dose you have almost no side effects! Less than with gabapentin or Lyrica...or topamax...kind of
Another thing to look into is diet. My most stubborn pain...that even the narcotics wouldn't touch...was being partially caused by a lack of an amino acid called glycine. I kinda wonder if we with SM pain more severely/ stubbornly have a metabolic issue that keeps our bodies from making enough of it. It is the natural brakes for a spine pain regulator called NMDA. Foods very high in glycine, or a glycine supplement may help? It is something to think about and try anyway.
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Re: Pain clinic

Postby JeffinMI77 » Mon Apr 23, 2012 10:44 pm

I replied to your other post as well but wanted to comment on this. My pain Dr. is like number 3 in the post above. She monitors all narcs closely and I have to use one pharmacy. My PCP cannot prescibe any Narcs to me. She is even taking over my Xanax. The good part is that she is able to adjust the meds when she feels the need, my PCP was a little nervous about it because of all the issues with Rx drugs these days.
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