So I had my appointment at the pain clinic yesterday and though I don't know how the new med will work yet I am very happy with the treatment I got from the doctor and nurse there. It was a very positive experience.

The nurse did the intake stuff and had me fill out a few more papers, sign stuff etc. She was very nice but did express concern over my weight, I know I need to lose a bit but I'm not extremely overweight. Then I went to talk to the doctor and explained everything that has happened since I was dx with FMS in '97, accidents, injuries and the major one last July. As luck would have it I was having the best day I've had in weeks so probably didn't appear to be in much pain. He has a great philosophy and even had a sign on his wall that said 'If someone says they have pain, Believe them'... I really liked seeing that and its obvious he does believe. He did his physical exam and all the sensory stuff and confirmed that its the s1 nerve. Then we go back to his office to talk..

He explained how injuries like mine heal on their own in a reasonable length of time in about 90% of cases, he said I'm obviously in the other 10%. He explained in great detail what is going on inside my lower back affecting the sciatic nerve root though there were some new terms \I didn't quite understand. He was good to explain though. He said injections might have been helpful last year when it was new and at its worst but he didn't feel they would be effective now. He also talked about cutting nerves but said the relief could be anywhere from none, to two weeks, to a max of 9 months. It would not get me back to work and I would have to drive to a hospital 4 hrs away to have it done... not worth it for me at this time.

Then we got into exercise and medications. He didn't dwell long on exercise but gave me a booklet he created and went on to tell me about all different kinds of medications in great detail. He then discussed why certain ones would not be appropriate for me and we narrowed it down. In the end we were just talking pain killers, mostly opiates. He told me in detail about drugs from the low end of the opiate scale right up to medicinal marijuana which he is the only doctor on the island licensed to prescribe it. In the end we decided to start at the lower end and work up if that doesn't work which seems quite reasonable to me. My one concern is that I don't want to be stoned all the time - I want to go back to work.

So all said and done he increased my lyrica; I was taking 100 mg twice per day... now I"m on 250 at night and only 50 in the morning to decrease my daytime grogginess but hopefully the higher dose will calm the nerve pain better. Then he prescribed Tramacet. I've read an old thread here on tramadol and see that alot of people don't seem to get alot of relief from it but he said to call him if its not working and he'll prescribe something else so I'm not too worried. I have tramacet 325/37.5 and will take 2 per day for 3 days, then 3 per day for 3 days then up to 4 every day. He was going to prescribe a Buprenorphine patch but I react to adhesives so he thought it best not to.

Other than that I went back and talked to the nurse and I've been put on a low glycemic diet. Its alot like a diet I did years ago for FMS so nothing new and I enjoy the foods and felt better on it so I'm good with that. Losing a few pounds would be nice too. She then showed me some pressure point therapy technique and I was on my way. I was there 4 hrs so there is alot more but this is way too long already. All in all it was a good experience and I'm happy with the treatment plan. I did have to sign an agreement to follow the plan, no alcohol, no driving while feeling 'drugged' and no one else can prescribe me opiods. No problem.