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Is it time to see a pain Management Specialist?

Started by 1066397748@facebook on 08/24/2011 12:33pm

I have DDD in the L3,L4, and L5, It was aggravated during an Injury at work...I have Tried to Exercise and lose weight as instructed, but I only pay for exercise with more pain, and since my injury 4 years ago I have gained 60 pounds. I have been seeing the same Dr. the whole time...I am a walking Medicine Cabinet, Ibuprofen 800, Robaxin 750, Flexeril 5mg (at night instead of Robaxin) Amitriptyline (supposed to make muscle relaxers work better) T3 (was for occasional flares of pain but recently is DAILY). At my last visit about 45 days ago I complained again that My stomach is getting irritated and the pain relief of 2400 mgs of Ibuprofen is not doing what it used to..the only response I got was 40mg Omeprazole and take LESS Ibuprofen. I tried Aleave and Tylenol, they do absolutely nothing!
My stomach is better which is good, and I tried to take only 1600mg Ibuprofen a day, that was hell. In the past, I have went through 2 rehab clinics to make me more tolerant of standing and walking, they really didn't help much I think they are after work-comp Money! My Dr. is a family practitioner, I really want to see a specialist and can, because my personal insurance allows me to see one without a referral. I will have to pay out of my pocket and I don't care!
So how do I go about getting a second opinion/specialist help?
I need my medical history, to take to the specialist, how do I go about this without making my Dr. think I want more drugs just for the high....I laughable thought..I HATE THE DRUGS but I know the damage Ibuprofen will do to me...Is Tramadol, or Oxycodone worse? Hydrocdone does not work on me...found that out with a knee injury.
By the way my pain has increased to about 5/10 with Ibuprofen and T3 and 6/10 with just Ibuprofen, and 10/10 without any, all of these are with Robaxin. I am trying to work, with a 6/10 pain level and deal with 5/10 at home, and my sex life is a joke! I can't do hardly anything around home. Its just about driving me crazy! HELP ME PLEASE!
If you know of someone in the northern 'burbs of the Twin Cities..hook me up!

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Matthew, First of all you have the RIGHT to an second oppinion! If this is, then a 3rd :)! I struggle with the same thing. Loratabs do nothing for me neither does anti inflammatorys. However, narcotics have been abused by so many everyone who are actually in pain get the beating for it, Literally! I haven't personally tried pain management but i heard that they do take insurance. I would call and ask what it takes to actually get in. I would also tell your family doctor you would like for him/her to make you an referral to a orthopedic back and bone doctor while your at it as well or as you say your entitled to do one yourself. Hope I helped alittle.

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I agree with PainNtheRear. You have a right to a 2nd opinion. 6/10 pain and above is NO joke. The drugs you are taking are not doing it and it is possible that you need more diagnostic testing so you need to see a back specialist and then if he/she recommends it pain management is an option when you consider the risk/benefit of a surgical procedure. Depends on whether your problem is JUST DDD.
To answer your questions about other drugs. Tramadol can be very effective and it won't ruin your GI tract. It works for some people very well (myself) but others have some side effects like nightmares. It does keep me awake so I can only take it in the morning/early afternoon. It is a whole lot safer than amitriptyline too. Tramadol has some anitdpressant activity so some people get a double benefit. If your pain gets to 10/10 (I had that only once when I had a kidney stone) then you should not be afraid of oxycodone. A pain management specialist can help you with that. You can find the minimum dose that makes you functional in your life. Oxycodone does have side effects --it shuts down your bowel but there are work arounds for that problem. You need to be able to work and having 5/10 pain means you can't do a good job at work as that level of pain is hard to ignore.
Good luck to you.

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As someone who has dealt with the same problem for over 20 years (what you describe is how my isssues started), I have several suggestions.
First, if your Dr would be "offended" by you seeing a specialist, then he is not looking out for your best interests. But if you think it would be a problem, request a copy of your MRI and radiology report from the facility that did your MRI. that should be enough to get you in the door for the the next step. You have two options; seek out a FELLOWSHIP trained ( that is the highest training possible for a Dr) orthopedic spinal specialist in your area, or seek out a Physiatrist in your area. You can use Google to start out. A physiatrist is a pain management Dr who specializes in spine issues.
As for meds, it sounds like you need to explore Celebrex in lieu of the ibuprofen, it is designed to be much easier on the stomach, I've personally taken it for 10 years and it was astounding the difference. As for pain, and I AM NOT A DOCTOR, just someone who has lived through what you are going through! That said, Hydrocodone comes in many different milligram dosages, if you didn't get somewhere towards a 10mg dose previously, it still may be something to explore. If that doesn't work, Oxycodone (Percocet) is the next step. And speaking from experience, it is NOT the "big bad wolf" some would describe it as. Yes, it does have side effects, but so does Hydrocodone, and yes, it can be addictive, but so can Hydrocodone. After using Hydrocodone for several years, I have also had to switch to Oxycodone. As much as you don't want to hear this, this will probably be something that you have to deal with the rest of your life, so it's important that you use the least amount of pain meds that you need to be comfortable. Because in the future, your body builds up a tolerance to pain meds and they will have to be increased to get the same amount of pain relief. However, I would also suggest you read about the concept of "Chasing Pain". Anyone dealing with a chronic pain condition should read about it. Last, with a physiatrist, you can also check into injections (usually done in a series of three) that may be of great benefit to you. They are sometimes referred to as nerve blocks. And btw, with a physiatrist, after providing your MRI to show your condition and what you've been dealing with, you should not have a problem with being made to feel like you're a "drug seeker". Yes, they may be strict about their dosage and refill policies and making sure you are taking the pain meds as directed, but this type of Dr deals with pain management everyday and most have learned the difference between someone that is truly in pain versus someone seeking pain meds with bad intentions.

I hope some of this helped. Good luck to you

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Pain medications are a very individual thing. For me, Celebrex does absolutely nothing but it might help you. However, Celebrex has many of the same heart side effects of its more effective cousins, Vioxx and Bextra, that were forced off the market --not as bad perhaps but they are still there and present also in ibuprofen. I was very said then Vioxx and Bextra were banned because they worked for me. Another possibility is Meloxicam. IT is sort of inbetween ibuprofen and celebrex. I found it much more effective than Celebrex and for a while I combined it with tramadol. Celebrex and meloxicam (MOBIC) are easier on the GI tract, but again not absolutely safe. SO you may need to do some experimenting. What others have said seems pretty much on track although I never saw the kind of physicians they mention. I went straight to a pain management clinic and my doctor was a anesthesiologist specializing in pain management. Also, various kinds of injections COULD be helpful to you and a pain management doctor should be qualified to use these.

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Your words of encouragement are really helping.. (PNtR, LK, M13 thank you for your input)....
Work-comp is a tricky deal..
I should add, I did see a spine specialist, [Editor's Note: Name of the spine specialist has been removed. Please refrain from naming health care professionals in the SpineUniverse Community]....I spent less than 5 MINUTES with him..."You're not a candidate for surgery." (aka THE INS. CO. WONT PAY) But my QRC was there and work-comp was paying the tab...I'm positive there is corruption there, I don't really care what it takes, I want the pain to at least be tolerable, (1-2/10) we don't let dogs suffer why should I!
I know that this will be a LIFE long thing, I had this argument with my Doc's nurse about a Robaxin refill. (I was going out of town, my Doc is impossible "also out of town" to get appointments with, and I needed a refill, for drugs I've been taking for 4 years and probably THE REST OF MY LIFE), I told her get me an appointment that works in our schedules, I'll be there! She shut up real quick!
I am going to ask for a referral with my doc first, if that fails I will go on my own be damned of what my doc or work-comp thinks. A Physiatrist sounds like something [the spine specialist] should have suggested. I will keep everyone informed....

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HI mathew, read ur story and like eveyone else complaint along with mine,all the docs ive seen and pain management ,they do not give out the narcs because they all think we are narc seeking.my experience is posted, pleas read, and I hope my info helps,I am an experienced nurse in orthopedics,went through same as everyone else, had my surgery in march and then 2 weeks after surgery BAM! the chronic severe pain started.I got to the point were i was loosing my mind, and yes sex life down the drain along with my mental stability,and my daily life routine.and lost my ability to work as a nurse.good luck to u, and again I hope my suggestions listed in my story helps you, my name is Rene,u will find it listed in the discussion forum,hope it helps u as much as it did me.

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Matthew: Just a bit of a warning for you. I have and am currently dealing with workman's comp issues relating to carpel tunnel problems dating back to 2005. IF your primary workman's comp Dr won't refer you to a Physiatrist (that is still my best recommendation since you've already been deemed as "non-surgical", then do some research for your area and get a workman's comp attorney. Use this as a last result because it can also slow your case down. Actually, first I would call your case manager with your workman's comp insurance company and see if you get anywhere. you do have the right to a one-time Dr change with workman's comp, but they get to choose the Dr. But with an attorney, you can at least choose the type of Dr. If you try to use your primary insurance, it may cause you trouble in the long run. It could go either way since you said this "aggravated an old injury". But if they find out this is a workman's comp issue, you may be put in a position to have to repay anything your primary ins co paid out. You may deem it worth the risk since you are so miserable. If you do, google for a physiatrist in your area, tell them this was an old injury that workman's comp doesn't seem to want to take responsibility for. That's what I ended up doing and worked for me. But IT'S STILL A RISK. FYI, a workman's comp lawyer would probably love your case, they love back injuries!

One "treatment" suggestion, have you tried ice? And I mean a serious ice/gel pack. Go online to the Relax the Back store. They have a big ice pack for about 40.00. If you can get through the first 5/7 minutes with it, it will actually numb the area it's on. It's been a lifesaver for me! I absolutely live with them. My freezer has more ice packs then food! Lol. My personal recommendation is not to use a heating pad. Alot of people do, but it may feel better while you are on it, but it may cause more swelling in an area that is already inflamed and you may be more miserable afterwards. Also, when you are in bed, elevate your legs so your back is TOTALLY flat against the bed. And I'm not talking 2pillows. I'm 5'8" and it takes 5 pillows for me. And don't let your feet hang down, it just puts more pressure on your back. Try 2rows of 2-3 stacked pillows, it helps alot. When I lay down, it is literally the first deep breath that I think I take all day. And if you lie on your side, put a pillow (or 2) between your legs so your hips are even.

Good luck to you.

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Matthew: Just a bit of a warning for you. I have and am currently dealing with workman's comp issues relating to carpel tunnel problems dating back to 2005. IF your primary workman's comp Dr won't refer you to a Physiatrist (that is still my best recommendation since you've already been deemed as "non-surgical", then do some research for your area and get a workman's comp attorney. Use this as a last result because it can also slow your case down. Actually, first I would call your case manager with your workman's comp insurance company and see if you get anywhere. you do have the right to a one-time Dr change with workman's comp, but they get to choose the Dr. But with an attorney, you can at least choose the type of Dr. If you try to use your primary insurance, it may cause you trouble in the long run. It could go either way since you said this "aggravated an old injury". But if they find out this is a workman's comp issue, you may be put in a position to have to repay anything your primary ins co paid out. You may deem it worth the risk since you are so miserable. If you do, google for a physiatrist in your area, tell them this was an old injury that workman's comp doesn't seem to want to take responsibility for. That's what I ended up doing and worked for me. But IT'S STILL A RISK. FYI, a workman's comp lawyer would probably love your case, they love back injuries!

One "treatment" suggestion, have you tried ice? And I mean a serious ice/gel pack. Go online to the Relax the Back store. They have a big ice pack for about 40.00. If you can get through the first 5/7 minutes with it, it will actually numb the area it's on. It's been a lifesaver for me! I absolutely live with them. My freezer has more ice packs then food! Lol. My personal recommendation is not to use a heating pad. Alot of people do, but it may feel better while you are on it, but it may cause more swelling in an area that is already inflamed and you may be more miserable afterwards. Also, when you are in bed, elevate your legs so your back is TOTALLY flat against the bed. And I'm not talking 2pillows. I'm 5'8" and it takes 5 pillows for me. And don't let your feet hang down, it just puts more pressure on your back. Try 2rows of 2-3 stacked pillows, it helps alot. When I lay down, it is literally the first deep breath that I think I take all day. And if you lie on your side, put a pillow (or 2) between your legs lenghtwise so your hips are even.

Good luck to you.

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Sorry, one more thing. You need to be sleeping on a good, firm mattress! If you aren't, then that's something you need to explore. And btw, I personally do not recommend mattresses with "pillow-tops". Some people love them, but after a few hours on one, I regretted it and bought a one without a pillow-top. I dont think someone with a back problem needs to be "sinking down" into anything. And that includes recliners and sofas. You need chairs that offer good support.

And the best exercise advice I got was stretching as much as you can and WALKING in a pool. Not swimming, just walking. It keeps your muscles strong and there is no resistance in a pool.

Take care!

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Hi mathew, I agree about the celebrex, after taking it for 3 days my pain scale whent from a 200 to a 3, I also started using a TENS unit , which fortunatly my insuranse so between the celebrex and the tens ive improved in 3 days, I also see psychotherapy, which i encourage to all, they have me on cymbalta for the depression that comes along w our issues of dealing with our life change,also klonopin 2mg 3x daily which helps mind,and also muscles which is a big help.I got cheated out of workers comp because my symptons didnt start till months after my accident on jj
ob, Im a nurse and had a 425lb patient fall on me and i weigh only 132lbs. Since Dec6 ive been out of work,any suggestions on some sort of compensation financially? Fortunatly I have a Hubby that does well and can financially carry the household, I have 2 daughters in RN collage, we get no help financially in that department because they state he makes to much money, (ya sure), living on Long Island, we all now how expensive that is,along w/ all bills that come along w dr visits.copays and meds. Todays economy is goin down the tubes,,,so since im out of work, we had to make some lifestyle changes and were just doin the best we can, as so many others r. I hope ur case goes well and u to feeling better. its been a weeek since I entered the group and everyone has been so nice n supportive, glad I found the site. Good luck stay, stay well Rene :)

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