Pain management question

[kari1980]

Hi,
I was wondering from the people that have gone to pain management clinics, how does that work? Do you just go and tell them you have IC and they give you pain meds, or do you have to go through testing and stuff? How does it work, I would really like to know because my doctor won't give me the Percocet and I'm in so much pain right now.
Thanks,
Kari

[ihurttoo]

There are 2 different kinds of pain clinics. Some only do nerve blocks and dont prescribe meds. Others will prescribe meds in additon to doing nerve blocks, physcial therapy, etc.

Almost all pain clinic require a referral. Usually, the Dr. who is treating you for your IC would be the one to ask for one, but if he/she declines, you can always ask your Gyno, or your GP.

When they refer you, the pain clinic usually has them send over your records, including your labs and surgery reports showing pics of your bladder. So, they dont do any kind of exam "down there". They will generally take your vitals, and possibly feel your abdomen, back, etc. But, mine only did this on the first visit.

They generally have you sign a contract that you will only use one pharmacy, and that you will not get pain meds from any other Dr. If it is an emergency, or you are having surgery, or a dental visit requiring extra meds, all that has to be cleared with the pain clinic first. They also have you sign that you will bring all your meds to each visit and submit to random drug screening and pill counts.

They also have you fill out a sheet each time with a diagram of the human body and have you circle where your pain is located. Then, they have you rate it from 1-10 before meds, and then 1-10 after meds. They also ask what makes the pain better, (heat, cold, hot baths, etc.) and what makes the pain worse. They ask if walking, sitting, standing, laying, etc. makes it worse. and if any position makes it better.

Then, they have you describe the pain, and circle the word or words that best describe it, (numb, tingling, burning, cramping, shooting, etc.) They also ask if it is constant, or if it comes and goes.

They ask if certain foods or beverages make it better or worse and for you to list those that trigger your pain.

They ask what meds you have tried. What meds helped, and which made them worse. What side effects did you have from each of them, dates you started and stopped them, etc.

They also ask if you have tried nerve blocks, surgery, physical therapy, TENS units, biofeedback, etc. Some clinics have asked patients if they have tried instills, (though mine didnt ask that, though I do use them.)

They also want to know if you have any conditons that could contribute to the pain such as depression, anxiety, or any co-existing or secondary conditions such as Fibromylagia, endo, arhrititis, old injuries, etc.

Some pain clinics r/x narcotic pain meds right away, based on the patient history, (like if they see the patient has tried everything else and nothing has worked.) Others, try nerve blocks, physcial therapy, pelvic floor therapy, antidepressants that help with pain such as Elavil or Cymbalta, or neuropathic meds such as Neurontin, Lyrica, or Keppra, etc. first, before they will try opiate therapy. Sometimes, they try other things for months before they try narcotics, as it can take a while to try different dosages on the same med and then different meds. But, like I said, others, r/x pain meds right off the bat. It really differs from Dr. to Dr. and clinic to clinic.

Some pain clinics also have Psychologists or Psychiatrists there in the clinic and require that all pain patients see them for a certain number of visits to help them cope with chronic pain. (Mine doesnt have one, but I have heard of several that do.)

That is about all I can think of right now. Hopefully, others will chime in with their experiances, and can fill you in if I forgot something.

I hope you find something that helps your pain soon.

Hugs,
Amy
Most pain clinics require monthly visits.

[Babs RN]

All righty then. I don't think I can top Amy's answer, it so all inclusive. Great job there, Ms. Amy! I can add some of my experiences here and if you would like some details, please PM me. I can't share alot of details here on the boards right now. Anyhoo, my pain guy didn't require a referral but follows the same guildlines as Amy's clinic. I had to sign a contract to use him, the same pharmacy, reporting in with Emergencies, etc. I might add that I have been very honest when other docs offer pain meds in light of my affiliation with a pain clinic to include the new extended release Opana. The honesty has given my pain doc and I a very mutually respectful as well as patient/doc and nurse/doc relationship. I submit to random UA's every 3 months to make sure my levels are where they should be in my blood based on my prescribed doseage. They also test for illicit drugs as well. The biggest things they are looking for on the urine tests are: that you are taking the meds as prescribed, not supplementing them with other non FDA approved pharmaceuticals provided by the unlicensed rep on the bike, and that if your levels are too low, especially with the long acting meds, that you haven't picked a part time job if you know what I mean. I am a huge fan of pain management clinics and to this point have had about 90% success in the 8 years Ihave been diagnosed. Hope my rambling has helped and that yoor pain is relieved. As a nurse, don't even get me started on some of my colleagues who don't assess pain unless you hit them withy a cannon.

Hugs,
BarB

[Sarojini]

Can't really top the info you've gotten already here, really.

I can tell you what goes on at my pain clinic, though. First, you get a referral to the clinic from one of your doctors (uro, primary care, whatever) because my clinic will not take you without a referral. The pain clinic then looks at the records that were sent over and decides whether or not they can help you -- I was in luck because they decided to help me. They had a few IC patients already and were interested in learning to treat more.

Before my first appointment, they sent me a pack of forms. Some were regarding insurance, and another was a fairly long questionnaire about my pain -- my diagnosis, how long I'd been having pain, where the pain was (I think there was even a picture of the body so I could shade in the parts that hurt), what kind of pain it was (cramping, aching, shooting, stabbing -- there was a list of words to circle), what made the pain worse, what made it better, etc. I was to bring the questionnaire to the clinic with my first appointment.

When I arrived, I met with the doctor, and we discussed IC, my pain, and generally my answers to the questionnaire. Since I was already on a narcotic regimen from another doctor, they decided to continue that but increase dosage a little. They also described other services they do (including nerve blocks, providing a psychologist to see should I want to discuss any issues my pain caused, referrals to physical therapy, etc).

I then had to sign a narcotic contract in which I promised not to get pain meds from other doctors, to use the same pharmacy each time I filled scripts, to take the meds myself and not sell them, to bring my pill bottles to each appointment for them to count the remainder, to agree to any urine drug testing they might want to do in the future, etc.

They did the pill count for the first few visits, but have now stopped since they've decided I'm trustworthy, apparently. Also, I have not been drug tested to date, but I don't worry about it since I don't abuse these meds... it is a small price to pay for relief!!

Since then, we've changed meds a few times to optimize my pain control, and basically, even though they are sometimes rushed, I am very, very glad I go to the clinic

[kari1980]

Thanks so much for all of your replies, that really helped me a lot...I would be nervous about the pain bloc, I don't want to get that...and all of my records are in another state from numerous doctors over the years, so would be a challenge to get all of them, since they were from 1994! I will definitely give it some consideration though if I can't get any help from any doctors here. Thanks again for the great replies, I appreciate it...

Kari

[ihurttoo]

JEn's post reminded me, they also sent me a packet of infor to fill out before the first visit, and at the end of the first visit he agreed to take me as a patient. (I had thought that by virtue of booking my appt and accepting the referral from my Dr. that meant they were taking me, but at first, they told me they couldnt help me. The Dr. initially didnt think IC was "that bad", since he had no other IC patients (and hadnt heard of it.) But, after I explained that since my Dr. who DOES know about IC referred me there, HE obviously thinks it is "that bad", and that since the US Govt and 2 Drs. declared me medically and legally disabled, that they must also agree with me that it is "honestly that bad". After I said all that, I was ready to walk out, and that's when he apologized and said he truly meant no offense and honestly didnt know it could be that bad and then he agreed to take me on as a patient.

It was rough going there for a few minutes, but thankfully he changed his mind and agreed to treat me. Like Jen, I have been helped alot by my pain Dr. Though I still have alot of pain every day, the combo of meds and bladder instills have finally brought my base daily pain level down to about a 4-5. (It still spikes back up to about an 8 at various points in the day, but I have a breakthru med for when that happens. Hopefully, you will be helped too.

I hope that you get your pain under control soon!

Hugs,
Amy