You know, primary care physician's really don't know how to treat chronic pain patients. When I lived in a rural community I used to drive 2 hours to the main City (Miami), to see my pain management Doctor, it was well worth it!
I wouldn't see a PCP for chronic pain. They are afraid of prescribing strong opiods, they are quick to label the patient as a drug seeker, and they do not know how to titrate a medication, so for those reasons and many more that I can not think of right now, I drove 2 hours.....

If you can handle the drive, or have someone that can do it for you, you will be better off to go to see a pain management Doctor. It will save you headaches, heartaches and stressful situations in the long run.

I completely agree with Tipper!

I live in the Chicago suburbs and still choose to drive 3 hours round-trip to the best pain management doctor I know of. It is well worth the trip.

My PCP was fine giving me 30-45 hydrocodones per month, but once I got passed the point were I could live with that I had to go to a pain management doctor. You do not need a PCP referral necessarily. I never had one and I've seen 3 pain docs. The first one was an opiophobe who only wanted to do procedures and Rx muscle relaxers that did not work well for me. #2 had a terrible PA who thought I was a drug addict and put me through hell while neglecting to prescribe anything to touch the pain. #3 is extremely intelligent, compassionate, and easy to talk to.

It may take you several tries to find the right doctor for you. Most methadone clinics don't take chronic pain patients, BTW. And you really don't want a relationship with a doc who doesn't feel comfortable with chronic pain patients. Save yourself the grief.

Yea, pain clinic is the in the right direction. My PCP treated my pain for a year and she had a difficult time with it, at least on how to actually treat my pain. Also, it was hard to get refills. She would only give me at the most 2 weeks supply. Sometimes it was even hard to get a hold of her to request a refill. Now that I'm under the charge of a pain doctor, everything is automatic with refills and I just do follow ups every 3 months unless my pain gets worse, then I need to call.

Thankfully I don't need to travel far for the pain clinic, even though I don't have to see him that much. I do however have another specialist that I see that is 2 hours one way and is WELL worth the trip! It certainly makes a difference when you have a doctor that knows what to do and how to do it. You just need to find them and don't sell yourself short. You are worth the effort!

I do appreciate your advice from each of you. My PCP now is an internist who sees several chronic pain patients and in the past had talked to me about different medications and pain patches. Over the last year or so he's become more temperamental. I chose him because of recommendations from others. He's an elderly man with a small practice and only works 4 days a week.

There are 3 Pain Management Clinics and one doctor who specializes in pain control within 50 Miles of me. Every single one of them says they won't make an appointment for me without a referral even though my insurance company doesn't require referrals.

My main objective is to avoid those places who do many injections and other invasive testing for spine conditions.

I keep up with current information from the field of medicine and know these methods do have a high percentage of adverse side effects. If not immediately, years later.

It's been 25 years of suffering and the treatment of chronic pain patients hasn't improved much at all. Doctors seem to see it as a way to make money and treat people very much the same. I just need to be respected for my intelligence and unwillingness to be a guinea pig.

Rosetax,
Absolutely you should be respected and the leader of your pain control team. Many pain docs do want to do pricey procedures in addition to giving meds. You may let a prospective doc know that you've tried those procedures unsuccessfully and about your concerns about the long-term effects. However, do keep an open mind because medicine has changed a lot over the decades and you never know what will help! Have you asked you PCP for a referral and if so, what did he say? Pain clinics want this just to know you are for real and not just a druggie.

I see your point of view regarding pain management doctors, however, I feel that every doctor is different. You may be surprised at what they can offer. They are specialists in pain management. Like any profession, they have their over achievers and their slackers but I have been very happy with mine. I travel 4 hours each way just to see her. I sought out a local pain management specialist and was surprised by the differences in treatment procedures. I had an emergency recently and contacted both specialists. Only one responded. I still have yet to hear from the local doctor. It's been over a week.
Additionally, primary care doctors are increasingly unable to provide long term prescription drug treatment. Medication monitoring is forcing chronic pain sufferers into pain management. The sooner one finds their pain management doctor match, the better.

I'm waiting to talk to my dr Monday about the referral. What if I don't like that particular pain clinic? I hope I can get a referral to another one.

My biggest gripe are those pain doctors who refuse to prescribe pain meds until after you try the epidurals and nerve blocks.

There's a url you may find interesting. www.researchchannel.com They have a video library. The Harborview Spine Clinic in WA state has many lectures given by specialists. Some very technical but if you are knowledgeable about the spine and it's various parts and nerves you'll learn a lot. Some doctors are beginning to avoid discectomies because it causes other discs to degenerate.

There is so much you aren't going to hear about unless you do keep up with studies and lectures.

Like I said, some doctors are basing their income on many procedures that aren't FDA approved and/or known to cause irreversible damage and severe chronic pain. Surgeons are included and just because it's the "fad surgery" of the decade doesn't make it the best treatment.

I like surgeons who are all about repairing structural issues that are causing nerve damage or instability of the spine.

Rosetaz,
I met 6 different pain management Doctor's until I found the one that I have been with for 2 years now, so if you don't like the one that they give you the referral to, you can always keep on looking. Also a lof of the PM Doctor's have websites that you can see what their practice is all about, and you can always ask when you call to make your appointment.

When I first met my current PM Doc I told him about all of the ESI's and spinal blocks that I've had in the past with no results whatsover, and his answer was; "Well, I guess we won't try that here with you!", and we then went into discussing pain meds. My PM Doc is an Anesthesiologist that decided to get board certified in pain management medicine, so that could be what you need to look for.

Before you make the appointment, check and see if the Doctor is a member of The American Board of Pain Medicine (www.abpm.org), or The American Academy of Pain Medicine (www.painmed.org), and since your insurance does not require you to get a referral to a PM Doc, check on those sites and see if there is a Doctor that practices in your area and then call and see if they truly require that referral, then if they do get one for that specific Doc after you have asked all of the pertinent questions. Good luck finding a good PM Doc. Sometimes we have to "kiss a lot of frogs" before we find the right Doc, but once you find it, is darn worth it!

Take care,