When is it time for Pain Management Doc?

Hi Everyone-

Was wondering what everyones take is on when is it time to see a Pain Management Doctor?

My pcp has mentioned it and my neuro is hoping we can avoid it. I have had a rough summer and have used more of my Hydrocodone than normal. My pcp has never denied a refill or if I need something stronger than the hydrocodone but has stated that he thinks that my next step may be to go to Pain Management.

I am on some preventatives as well, as we all are...up until summer began I was getting along quite well. I can't help but think maybe now I will start a trend of feeling better again? Or maybe that is just wishful thinking?

I have also been to the ER/UC/IV Center a couple times this summer, but never admitted to the hospital which is a good step for me...

Also, is it true that some PM docs don't take on patients with CDH or Migraines? For some reason I thought I heard that at some point? Not for sure...

Thanks everyone! I see my PCP tomorrow and would love to get some advice from you guys, the true "experts" of migraines!

Hugs from Nebraska-
Carlajo:)

I saw a pain management doctor for a number of years who was very kind and tried every thing he could think of (mostly cortisone ruins in the vertebrae and facets). But the reality is that you need a good neurologist with expertise in migraines. They know far more about how to treat this disease.

My advice would be to stay away from the pain meds as long as you can. I would exhaust all neuro type options first. If a pain doctor would help treat the pain from other routes, such as injections (occipital nerve block, trigger point, Botox), alternative treatments, etc, then great. If its to get stronger meds, I would wait until you have exhausted all other options (ie. when your pcp & neuro says its time). Hydrocodone is actually a poor choice as the Tylenol in it is more likely to cause rebound than a pure narcotic, so hopefully that has been ruled out for you. I am actually on long acting narcotics and have been for the last couple years (have had a 24/7 headache for 5.5 years). It is a scary road to go down because you have to keep escalating doses to try to chase the relief you got in the beginning....I am far from that now.

I actually want to see a PM dr and can't find one! I have asked my pcp and two specialists and they don't know of anyone who would see me. Seems like there are very few in my area, and those that are here, just see back pain patients, do injections, only prescribe lower doses than I'm already on, etc. I saw one and it was a joke (he would have recommended a dose decrease when I have uncontrolled pain). So yes, just because they are a PM dr doesn't mean they will see headache patients or be willing to prescribe meds! I have read online about a lot of PM drs that prescribe a lot less narcotics than a pcp. Hopefully you live in a better are for non-cancer chronic pain treatment than I do.

I would see a different neuro if yours is out of ideas. If you take the occasional Hydrocodone because other abortives don't work, it has stopped working, your pcp won't prescribe anything stronger, and neither will your neuro, then yes maybe a certain PM dr could be of help. I got by for the first few years on just as needed narcotics, an amount small enough that my doctors didn't suspect rebound potential. Due to age though, that small amount still escalated in dose very quickly. That, or if you haven't tried injections that they might be able to do (although I've got those through neuros or referrals through neuros). There is far less ways to treat head pain besides meds than other types of pain though. Some alternative treatments like massage, pt, chiro, acupuncture, etc, are always worth a try. I particularly like massage because I don't feel there is a risk of me ever being worse off than I came in (I've heard chiro horror stories and think I was close to being one), and its quite relaxing and is great for tension relief...my insurance even covers it.

It is very typical to have to switch up the preventatives often, so if you were doing well and then declined, that may be a sign that you are due for a switch up, either doses or meds. Its rare for someone to go more than a year on a certain combo for example, and some get far less out of them. Sadly I have had no luck with the typical preventatives yet! But, I don't have migraine. My pain is less severe than migraine but is unrelenting. There are so many of them to try and they can really test your patience. Best wishes.

Hi All,

2002, my old and wonderful neurologist decided that the best thing to do was to manage the symptoms as preventative medications were not working and I was having to go the ER a lot. Fortunately, he had no problems prescribing the medications. He also had me see a colleague in Memphis (where I was attending school) so that he could be there if there was a problem. Oveer the past six years, I have tried most of the long acting pain medications. OxyContin, Fentanyl patch, dilaudid (short acting. for breakthrough), and Morphine. The one that worked best was MSContin 30 mg 2 times a day.

In 2007, the wonderful neurologist left private practice to run the stroke center and no longer sees priivate patients. My local neuro wasn't comfortable prescribing pain medicaation and sent me to a pain management dr. I havee been seeing him for about 3 years now. He is very good and did not havee a problem prescribing the medications I needed- MSContin. He did not really want to increasee the dose often though because he was worried about long term effects (I happen to know that I am one of his younger patients and he often says "you have a lot of life ahead of you." He is not at all worried about addiction or anything, just longer term effects on the body.)

About a year ago, the pain meds stoppeed working and I decided to get off the long term pain meds. One of the reasons I decided to go off them was that way too many people were blaming the fainting on the medication. Anyway, I am now on Tylenol 3 as needed. I am allowed four a day. Up until this last month, that has been working well. I see him later today and I may ask if we can add something stronger for times like this- when the pain is really bad.

If your neuro referred you, I would definitely get the name of the doctor and also ask the neuro the following question- "If you were sending your daughter/spouse/family member to pain management, who would you send them to?" I have found that this particular question usually gets you to the best doctor. Frankly, I would see the pain management dr- they may have some ideas and eveen if they don't, they probably know more about managing the pain than the neuro or they are usually more comfortable prescribing pain meds. They may also have some other ideas- nerve blocks, etc. I would make sure they treat migraine though, some do and some do not.

I hope this is helpful. Keep us posted.

Pain free days,
sailingm

Hi Everyone-

Thank you so much for the feedback and information about Pain Management! I am going to print out the responses and study the suggestions for when I have my next checkup with my PCP and also when I see my Neuro.

My appointment was okay. My PCP didn't mention Pain Management this appointment-he wants to see how the next 2 weeks go and then we will re-assess where I am. He did make some changes in my daily meds and he wants to see if that helps. I think he is hoping I don't have to go to Pain Management and I am DEFINITELY hoping to avoid it at all costs too!!!

So that is where things are for now. If anyone else has more information or suggestions in regard to having to see a Pain Management Doc, PLEASE let me know! I am feeling overwhelemed and scared. I really want to avoid going to a PM Doc if I can, but I also don't want to suffer every day with such bad pain and no real relief, either, you know??

Thank you everyone!
Hugs from Nebraska-
carlajo:)

"If you were sending your daughter/spouse/family member to pain management, who would you send them to?"

This is a really good question. Another good trick is to ask a nurse when you need a recommendation. They have a lot of inside information about how doctors treat their patients and know exactly who the best ones are for various problems.