Hi Ashlee,

When you get to your PM appt., they'll have you sign the typical medical forms. You generally see a nurse first to get all the vitals, just like any other Dr. appt. One difference is you may have to give a Urine Sample, which is used to see what meds you might be taking. If you've sent your Medical Records, Images, Test Results, anything that pertains to why your there, ahead of time the Dr. will have went over them hopefully. The PM Doc will examine you pretty thoroughly, get a history of your medical issues and your pain, what causes it, how bad it gets, what helps it, etc. If he's already went over your records he'll talk with you about them, if you're taking your medical records in with you, he'll take some time to go over them, and then talk to you about them.

After the PM Doc has examined you, gone through your records, etc. he'll then talk to you about what he thinks is the plan to treat your pain. This may or may not include medications. If your on medications already, unfortunately the PM Doc doesn't have to automatically keep you on them....its' up to his discretion. Generally they suggest several different forms of treatment, even if you are given narcotic pain meds, generally PM Docs like for you to use multiple types of therapies to treat your pain.

If you do get put on any type of Narcotic/Opiod medication, including Tramadol, you'll be asked to sign a Pain Contract. The Pain Contract is a Contract between you and the Dr. and it basically says that while under his/her care you are not allowed to get Narcotic/Opioid meds from any other source. That you agree to Urine Tests and/or Pill Counts to prove that your taking your meds, as instructed, whenever asked. That your meds must be stored in a med safe or other "locked" place. That you are not allowed to to share your meds, and if you violate any of these Rules (there are others on there as well) you can/will be dismissed from the Practice.

Pain Management Docs are not known for their warm, fuzzy bedside manner, they can be brash and very direct. They deal with true Chronic Pain patients each day and they deal with drug seekers pretending to be in pain looking for drugs each day....they tend to have their guard up more than other Dr.'s. It can take some time, them trusting you, and you trusting them, before they loosen up and begin to feel caring.

The most important thing is for you to give them as much information as possible regarding your pain, what triggers it, what time of day its worse, how long you've had it, what's the highest it goes, etc. The more information they have, the better they can treat your problems.

Good luck and take care.

welcome...hugs

Be sure to read the Pain Contract carefully. Once you sign it, telling the dr that you didn't understand what it said or you forgot will not matter. If you break the pain contract, the dr can dismiss you without any pain meds and it may be very difficult for you to find another dr that will manage your pain, if you can find one at all.

Some drs give pain meds on the first visit and some don't. They will want a list of all of your medications, who prescribes then, etc. Some insurance won't pay for the drug screens and some will. The may also take a picture of you to put in your file. This is for your protection as well as the drs. If your picture is in your file, they will know that is it you. Remember the dr has countless patients and the dr and his staff can't remember every patient or their details.

Hi Ashlee,

I checked with my insurance before entering pain management to see what they would cover. My surgeon referred me and he had good records regarding any PT, Nerve Blocks, ESI.mand any other procedures I had received. He also had an up to date list of all my meds. So when I got to first appointment the doctor had all this.

I can only add a few more things on drug contract. In an emergency that might require more narcotics there should be a 24 hour # for someone to be reached. The contract will state you must take meds as prescribed and if changes need to be made you must contact them first. My doctor has a three strike policy about canceling appointments or missing appointments. You are fired.

What impressed me about the contract is the doctor contracted with me. To be compassionate. And several other things
which I can't recall.

Good luck.

hippy

Great answers.
I just want to add that a good practitioner will
Not make you feel like you are some sort of a hypochondriac.
A good one will also ask you if you have had some sort of psychological conseling for your medical problems.
The visit should take at least 30 min.

The two pain doctors I've seen both pretty much continued my current pain medicine drug, they just cut the dose down by 20 Mgs per day. Some pain management doctors will feel more comfortable giving you narcotics on your first visit if you have been on them for a long period of time. You are at a lower risk for complications. One pain doctor continued me on narcotics while preparing me to receive a spinal cord stimulator. My current pain management doctor continued me on my narcotics, but he is also trying other medications in combination with the narcotics to help me. This particular pain management doctor does not want perform any operations on me unless sit is a last resort. He will not do any injections or nerve bocks on my leg because the pain is in the entire leg and because I am on blood thinners and a high rick for bleeding during the procedure. He decreased my Norco and put me on a low dose long acting pain med. Both pain management doctors made me sign a pain contract. But none of them have ever counted my pills or made me pee in a cup. I am willing to do both, but they have not required it. I don't know if it is because I am on less than 60 Mgs of meds per day or what. If you find a good pain management doctor, he will listen to you and work with you to bring your pain levels down. I hope this helps. Good luck! Hugs!

J

I can't believe it, but there are rare occasions, exceptions. I have a friend who goes to a pain management Dr., but I am not sure if he practices alone or what the situation is, but she is and has never been drug tested, nor had her pills counted.

If they did test her, she'd be in big trouble. I don't think she signed a contract either! I still can't believe he doesn't test her.

Again, it's very, very rare that happens.

I keep shaking my head that he doesn't. :0

I wasn't with my first pain management doctor long enough to be piss tested. I was so scared of having the surgery for the spinal cord stimulator. Not just because I didn't want wires inside me, but because I can have serious complications from just minor surgery with my two blood clotting disorders. I'm terrified of any surgeries. My current pain management doctor is fresh out of medical school. He is kind of lax and caring. I can see that he is not jaded. He really believes in his patients. That is eventually going to change when he gets burned a few times. Two months ago they made us all sign a form that states all opiate medication will be discontinued if it does not make us functional. I guess if his patients are not seeing an improvement in function, he will be cutting people off of their meds. I am ready for pill counts and piss tests. I have nothing to hide. I think that the piss testing and the pill counts are a very small price to pay for our pain to be managed. I used to be against it, but I also think the doctor should be protected from the DEA. Requiring piss tests and pill counts protects the doctor and the patient.

Pain contracts, drug screen and pill counts are all an individual drs choice. There are no laws that require these things, but they are recommended.

Each dr has their own way of practiving. So just because one dr has a three strikes policy does not mean that your dr will. Most drs require in the pain contract that you don't have any other dr but them treat your pain. Emergency situations do come up, but unless it is a situation where you are admitted to a hospital, you need to contract your pain dr before accepting any prescriptions for pain. It does not matter if you tell another dr that you have signed a pain contract, you agreed to check with your pain dr. Some people think that if they tell another dr that they signed a pain contract that that gets them off the hook and they are wrong.

I've been with my Pain Mgmt Doc for 12 yrs now and I've never had to do a urine test or pill count.

Sometimes its a relationship/trust thing, and sometimes its the ease of a known disease/diagnosis/illness.

Hi and welcome from me too. How did your appointment go? I really hope you felt comfortable with the doc and hope he or she will be able to help you. Regards Maddy.

Thank you all! I go Monday at 8:30. I'm pretty nervous because I really don't want to have to take opioids long-term, but I'm hopeful that they can try some different procedures that I've not already tried. The paperwork says that they do a urine drug test and that's fine with me. I was a psychotherapist before I got sick and I understand that addiction is a huge problem that doctors have to consider when prescribing medications. I'm already on Tramadol as needed, Flexeril as needed (probably helps more than anything), Celebrex and Gabapentin. I have a TENS unit and went to PT for several months last year. I did injections in the muscles around my lower back and they helped for a while and then quit helping. I had prescription pain cream that worked pretty well, but my insurance stopped paying for it and it was $900 a month. I think increasing my Gabapentin might be beneficial, but my rheumatologist won't try it because she thinks that if 600mg doesn't work, more won't either. I was hesitant to go after getting the referral because my quality of life and pain are better than they have been in the past, but I would love to be able to do more "normal" things. I will definitely keep you posted.

You have a little more wiggle room with the Gababpentin, the therapeutic dose for off-label use for neuropathy or nerve pain is around 900mg., after that you go into Seizure Disorder/BiPolar Disorder dosages of 1200 - 1800 mgs.

Also since Tramadol is now a Class IV Narcotic medication, that might be the one a new Dr. might be iffy about. Also Tramadol has an anti-depressant chemical that alters Serotonin levels, taking that with the Gabapentin, which also alters Serotonin levels, can cause dangerous side effects for some people. You might just want to make sure your taking safe doses of each.

Take care,

Update: My first pain management appointment went great! Everyone was so nice! They didn't do a drug screen or count my Tramadol and Flexeril because they understood about my conditions, even CVID (my rare immunodeficiency disease), and believed I was in pain. We are gradually tripling my Gabapentin from 600mg to 1200mg to 1800mg over the next two weeks and if that doesn't help enough, they said they be glad to give me something stronger. I'm being scheduled for a CT with contrast of my spine (can't have an MRI due to cardiac device) to see if I'm a candidate for epidural and nerve block injections. If I am, I'll get my first at my next appointment. I'm also going to get splints for both my wrists to wear when I sleep to keep my carpal tunnel from waking me up. We are considering aqua therapy, but she thinks we have to weigh the risk of regularly being in a pool as an immunodeficient person. I'll ask my immunologist, but I'm sure he will be fine with it. I feel very hopeful about what all of this means for my quality of life.