Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Suggest Medication For Pain Management
Question: I am having difficulty since I had to switch my pcp and hospital. My old pcp knew me well. I used to play 3 SPORTS ( kept returning to track, and the ski and ski jumping team) AND HAVE UNDERGONE MULTIPLE KNEE SURGERIES FINALLY RESULTING IN a left TKR. Also, have had 4 hernia repairs. I am 39 now. Obviously I have a high tolerance to pain medicine, even though I don't take it that often, and my old pcp made sure to write that pt has a hx of narcotic use secondary to multiple surgeries with signs and symptoms of abuse. that was exactly the truth. At this hospital my left knee has been labeled as "chronic" knee pain, as I occasionally still get pain and tramadol works well. Recently however, with in the past 6 weeks I got severe muscle spasms and cramping mid-low back with slight pain in my buttocks. Again, tramadol was given with valium this time. As time progressed the pain in my back went away and it was only in my left buttocks, post/lateral thigh, occ groin and yes even shooting and burning pain ant thigh. Despite calling my PCP, seeing the PA, only tramadol was given but they kept increasing the dose till I got to 12 tabs a aday, the valium was discontinued. Finally, I spoke to my PCP, and asked if we could change the medicine to an extended release of pain medicine 2x/day with the valium since the pain was getting worse and the exercises and tramadol with advil wasn't working. He had done that once when I had a few hernias repaired. This time he said no, but gave me a short course of Percocet with Neurontin, and valium. the burning pain has stopped. . But, I'm still taking just as much as the tramadol so, my goal of reducing how many pills I take in a day was not met. I see him in a day, and I will have my MRI results.
My biggest problem is I feel l the pt/dr. relationship is awkward and embarrassed to even ask him about pain medicine and he seems to be the one that understands the situation the best. If I happen to see the PA, I barely get evaluated never mind diagnosed with anything. I feel as though that "chronic" knee pain diagnosis has put a wrong stigma somehow. Maybe they think I am possibly drug seeking? I don't see how? I never see any other doctors, I try to do everything as they say. I need this resolved. I don't know if I should switch hospitals, I get so anxious just going to any appointments and even fear that I will not get the right treatment one day because of this. I feel as though drs are either over prescribing or completely under prescribing. I'm sure it can not be easy for the primary's, however, it should not take 6-7 weeks of agony to get something small prescribed for pain. My family is filled with medical professionals and I have followed their advice to speak with my PCP and he just nods and says he understands but does not. I know many doctors from my job as well that seea diagnosis and make assumptions all to easy and its sad that some doctors have lost that passion to really help people. He mentioned something about seeing a pain management specialist but no appointment has been made. In your opionion, how would you approach this very touchy subject with my PCP, and what referral should be made? The pain is still there, is it too outrageous to turn to something of an extended release nature 2x/day with the Neurontin for a little while? I'm not sure but I am quite afraid that a lot of people will end up turning to the streets to look for relief if doctors start cutting back that much on everything and everything. I keep reading about drug abuse everywhere, but there's a diff between abuse and tolerance. Ive had so many surgeries that I feel as though my body has adapted to low dose pain meds. it's like taking advil, so in these rare instances, where I seem to be having a 6-7 week long acute sciatica pain (never had before), how do I address the pain management issue when they are all so reluctant to give any out. Thank u
My biggest problem is I feel l the pt/dr. relationship is awkward and embarrassed to even ask him about pain medicine and he seems to be the one that understands the situation the best. If I happen to see the PA, I barely get evaluated never mind diagnosed with anything. I feel as though that "chronic" knee pain diagnosis has put a wrong stigma somehow. Maybe they think I am possibly drug seeking? I don't see how? I never see any other doctors, I try to do everything as they say. I need this resolved. I don't know if I should switch hospitals, I get so anxious just going to any appointments and even fear that I will not get the right treatment one day because of this. I feel as though drs are either over prescribing or completely under prescribing. I'm sure it can not be easy for the primary's, however, it should not take 6-7 weeks of agony to get something small prescribed for pain. My family is filled with medical professionals and I have followed their advice to speak with my PCP and he just nods and says he understands but does not. I know many doctors from my job as well that seea diagnosis and make assumptions all to easy and its sad that some doctors have lost that passion to really help people. He mentioned something about seeing a pain management specialist but no appointment has been made. In your opionion, how would you approach this very touchy subject with my PCP, and what referral should be made? The pain is still there, is it too outrageous to turn to something of an extended release nature 2x/day with the Neurontin for a little while? I'm not sure but I am quite afraid that a lot of people will end up turning to the streets to look for relief if doctors start cutting back that much on everything and everything. I keep reading about drug abuse everywhere, but there's a diff between abuse and tolerance. Ive had so many surgeries that I feel as though my body has adapted to low dose pain meds. it's like taking advil, so in these rare instances, where I seem to be having a 6-7 week long acute sciatica pain (never had before), how do I address the pain management issue when they are all so reluctant to give any out. Thank u
Brief Answer:
A long query requires a long response :)
Detailed Answer:
Hello ma'am and welcome.
Thank you for writing to us.
I have gone through your query with diligence and would like you to know that I am here to help. Yours is indeed a complicated case, let me explain why. Rarely do we doctors get patients who are really in need of pain management. I would say by my statistics in my practice I have seen about 99% of patients not really requiring pain management and only 1% or less really requiring them.
This statistic is most probably the same from doctor to doctor, making us doctors more and more hesitant to prescribe pain management medications. Some individuals who do not need the medication begin abusing it, resulting in addictions and in rare cases even death; leaving the doctor to blame.
I am sure you understand this, and it is this very scenario that makes doctors extra vigilant in prescribing pain management medication. But with your clear history, I would have suspected a pain management dependence even if you wouldn't have mentioned it in your query. Trust me ma'am, there is no easy way to explain to a new PCP to prescribe you medications that you really need when they are pain management medications.
I would try a few of the following approaches:
-Any saved old prescriptions from your previous doctor wherein, medications prescribed have been mentioned
-A summary from your previous doctor with your diagnosis and dependance on your pain management medication 'mainly' due to chronic pain, and not necessarily dependence
Note: What makes your situation a complicated one is "signs and symptoms of abuse". This is not comforting to any doctor who takes up your case, and the first thing that would come to any doctors mind on reading this would be " I need to be careful while prescribing pain killers for this patient". And there you have your problem.
-Try to make your doctor feel comfortable around you, do as he says, win his trust. And then start mentioning the severe pain you experience which is debilitating, and prevents you from going about your life
-Request him for pain management, and tell him you will do only as he says, and take the dosage he prescribes and nothing more. Make sure you follow that, so he knows you will listen to him
-Inform him that you are really happy with his treatment and look forward to seeing him every time a follow up is schedule (moral boost). Get personal with him, so he knows you trust him. And in a very casual way, ask him about the pain management specialist appointment and when it has been schedule
There is no guaranteed approach to such a situation ma'am, it can vary from doctor to doctor on how they think and how they are going to respond.
As for the extended release medications to be taken twice a day along with Neurotin, this in my opinion would be an extreme request (if a new patient makes this request), haha. I am just being honest, if you do not mind that.
I completely understand ma'am, unfortunately when it comes to pain management cases, doctors and patients need to both move forward and meet somewhere in between. You need to make your pain obvious to your doctor, and your doctor need to prescribe medications that help you and not harm you. So at the same time, you need to try to adjust with the grade of pain management being prescribed (sad but unfortunately the only way out).
I hope you forgive my brutal honesty, but I am speaking to you both as a friend and a medical doctor who deals with pain management on a daily basis (orthopedician and traumatologist). I also hope you can help your doctor better understand your situation and find relief to an extent at which you are both comfortable and not at a risk to the numerous side effects pain management can have.
Best wishes ma'am.
A long query requires a long response :)
Detailed Answer:
Hello ma'am and welcome.
Thank you for writing to us.
I have gone through your query with diligence and would like you to know that I am here to help. Yours is indeed a complicated case, let me explain why. Rarely do we doctors get patients who are really in need of pain management. I would say by my statistics in my practice I have seen about 99% of patients not really requiring pain management and only 1% or less really requiring them.
This statistic is most probably the same from doctor to doctor, making us doctors more and more hesitant to prescribe pain management medications. Some individuals who do not need the medication begin abusing it, resulting in addictions and in rare cases even death; leaving the doctor to blame.
I am sure you understand this, and it is this very scenario that makes doctors extra vigilant in prescribing pain management medication. But with your clear history, I would have suspected a pain management dependence even if you wouldn't have mentioned it in your query. Trust me ma'am, there is no easy way to explain to a new PCP to prescribe you medications that you really need when they are pain management medications.
I would try a few of the following approaches:
-Any saved old prescriptions from your previous doctor wherein, medications prescribed have been mentioned
-A summary from your previous doctor with your diagnosis and dependance on your pain management medication 'mainly' due to chronic pain, and not necessarily dependence
Note: What makes your situation a complicated one is "signs and symptoms of abuse". This is not comforting to any doctor who takes up your case, and the first thing that would come to any doctors mind on reading this would be " I need to be careful while prescribing pain killers for this patient". And there you have your problem.
-Try to make your doctor feel comfortable around you, do as he says, win his trust. And then start mentioning the severe pain you experience which is debilitating, and prevents you from going about your life
-Request him for pain management, and tell him you will do only as he says, and take the dosage he prescribes and nothing more. Make sure you follow that, so he knows you will listen to him
-Inform him that you are really happy with his treatment and look forward to seeing him every time a follow up is schedule (moral boost). Get personal with him, so he knows you trust him. And in a very casual way, ask him about the pain management specialist appointment and when it has been schedule
There is no guaranteed approach to such a situation ma'am, it can vary from doctor to doctor on how they think and how they are going to respond.
As for the extended release medications to be taken twice a day along with Neurotin, this in my opinion would be an extreme request (if a new patient makes this request), haha. I am just being honest, if you do not mind that.
I completely understand ma'am, unfortunately when it comes to pain management cases, doctors and patients need to both move forward and meet somewhere in between. You need to make your pain obvious to your doctor, and your doctor need to prescribe medications that help you and not harm you. So at the same time, you need to try to adjust with the grade of pain management being prescribed (sad but unfortunately the only way out).
I hope you forgive my brutal honesty, but I am speaking to you both as a friend and a medical doctor who deals with pain management on a daily basis (orthopedician and traumatologist). I also hope you can help your doctor better understand your situation and find relief to an extent at which you are both comfortable and not at a risk to the numerous side effects pain management can have.
Best wishes ma'am.
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
