I commonly see patients who were treated by a different doctor prior to seeing me. Most doctors are accustomed to seeing patients want to get different opinions or try different practices. Certainly, you want the new doctor that you are consulting or treating with to know as much about you as possible, including your history of past treatments and tests. You will likely need to sign a release form for your prior pain management doctor to send your records to the new one. If you feel embarrassed about this (but trust me most doctors' offices get used to this) it is possible that your primary care doctor has copies of these records and their office could send them to the new doctor's office, instead.
I think if you do some research on the new doctor and let him/her know why you want to work with him/her, then the new doctor will not only feel flattered but will have a better sense of direction of how to best help you. In other words make it more about why you are picking the new person and less about why you are leaving the old one to create a more collaborative working relationship. Good luck!View Thread
I know it can be really frustrating when you cannot find a physician who shares your philosophy about treatment or management, I thought it might help if I tried to explain some of the science behind why they may be recommending that you go in a different direction from continued opiate therapy.
Outcome-based studies generally don't recommend the use of opiates for the treatment of migraine headaches due to a lack of demonstrated efficacy. In addition, pain medications are now considered to be a major contributor of headaches, and this is sometimes referred to as rebound headaches.
What research has found is that the nerves in our brains are surrounded by these white cells known as glial cells, and they make up what is known as the "white matter" in the brain. Studies on migraine headaches have show that these glial cells release pro-inflammatory mediators that seem to be associated with the headache experience. Narcotic-based medications also cause the same activation of glial cells into inflammation-mode that is seen during migraines, and therefore may potentially aggravate the problem in the long-term. This may also explain some of the limitations of using opiates with other chronic pain problems. Research is being done to find ways to block this activation on the glial cells with the hope of making pain killers more effective in the future.
Again, I know your situation is very frustrating, but your doctors' recommendations may be based on some of these newer findings and recommendations and don't necessarily mean that they don't trust you or want to try to help you.View Thread
Thank you for opening up here and sharing your personal story. It sounds like you have been through quite a lot. I appreciate your concern about falling back into addiction. One of the things that I have learned from my patients over the years is that being in pain can be a very lonely and isolating experience. My patients often tell me that they felt like they were the only one going through what they were experiencing until they finally met other patients who were facing some similar challenges.
I think it can be very helpful to be connected with a group who understands what you are dealing with and can support you as you work through these medical problems. It might be helpful to look into what support groups and educational groups are in your community that you can connect with. While this may not be the solution for everything you are dealing with, the right group can boost your spirits, provide social support, and help educate you about ways that you can learn to better manage things. Perhaps one of your doctors or local medical center can guide to the right resources?View Thread
Thank you for sharing your situation with us. It sounds like you want to do everything that you can to feel better and stay active with your career and family at the same time. Hopefully despite some of the frustrations, your doctors admire your strength and motivation. I would like to give you some things to think about that you will hopefully find helpful.
Us humans are complex animals, and it may not be helpful to view your body like you would a car or a machine where you simply go in, find what is broken, and fix it or replace the part. If your doctor could do that, then he would be rich and famous. There are many different factors that can contribute to a chronic pain problem like back pain. Tests like X-rays and MRIs can give some information, but they don't begin to describe what a person is experiencing or going through who is dealing with pain every day.
Our healthcare system is not always good at understanding the many layers of the pain onion and providing effective and meaningful treatments for folks. When it comes to pain, modern medicine hasn't yet figured out tests that can understand a patient's pain at a deeper level, and as a result good treatments can sometimes be harder to find.
I think it would help to shift your view about chronic pain from just a symptom to seeing it as a chronic disease that you can learn to manage well. Try to think in terms of learning tools that will help you better control your pain and keep it in box as opposed to focusing on finding a doctor who can make it disappear. Start to seek out practitioners who can help you with management beyond the traditional medical walls if that isn't working. Things like developing a strong body, walking more, learning how to better manage stress, and finding the right emotional support to better deal with a very challenging problem can all help you gain tools that can help you feel better.View Thread
I appreciate your frustration with this problem and the impact that it has had on your daily activities. In doing some research on your interest in pursuing pudendal nerve decompression surgery, I wanted to give you some things to think about to help you decide what to do next.
First of all, diagnosing true entrapment of the pudendal nerve may not be clear cut. One recommendation uses this criteria: "if the pain is unilateral, has a burning quality and is exacerbated by unilateral rectal palpation of the ischial spine, with delayed pudendal motor latency on that side only." You may want to talk to your doctors about how confident they are in the diagnosis as a first step.
Another issue has to do with how successful is the surgery, even in experienced hands? In reviewing some of the published studies on the outcomes of decompression surgery, it seems as though there certainly are studies out there that show positive results. But, I would recommend caution in interpreting these results because the studies are typically done on only a small number of patients and the follow up is usually brief. For example, one study done in France had good results, but only followed their patients for 3 months after the surgery. In my opinion, the evidence thus far is limited. If you know of a surgeon who performs this surgery, you may want to ask to speak with other patients who have had it done and see what their experiences were like over time.
Either a pain specialist or neurologist could be good choices for help with treatment as both should have training in treating post-herpetic neuralgia (PHN). PHN occurs as a result of scarring and damage of nerve fibers after a shingles reaction, and it can be a very challenging problem to manage. As you probably know, shingles is caused by the chicken pox virus, and PHN exists when the pain persists after the infection goes away. About 20% of the people who get shingles will develop PHN, and it is more common in older adults.
Some of the typical medications used to treat PHN include nerve medications like Neurontin (gabapentin), Lyrica (pregabalin), and certain antidepressants like Elavil or Cymbalta, and topical lidocaine, in an ointment or patch form, can be very helpful. Sometimes nerve blocks may be tried, but evidence is lacking for their efficacy once the problem becomes more chronic. A pain problem like PHN can often be made worse by things like stress, so exercising techniques to better manage stress or anxiety will also help.View Thread
I think you are asking some great questions here, and it is wise of you to want to be very careful about mixing different medications. In looking at the data on pain medication complications and side effects, it seems that one of the areas of biggest risk is mixing different types of medications together. The use of different types of opioids, like Norco and Fentanyl, in conjunction with benzodiazepines used for anxiety like Xanax or Valium, has been associated with an increased risk of complications like accidental overdoses.
Because different doctors may be prescribing some of your medications, it is important to make sure that they all keep up to date on your current medications, and you can use your pharmacist as a resource to check medications interactions. Also consider that there is a wide genetic variability in how different people respond to the same medication. Certainly, the gastric bypass surgery may also impact drug levels of certain medications. Taking everything into consideration, it can be very difficult to predict the effects of mixing different medications that act on the central nervous system, and it is a good idea to remain very cautious. View Thread
Stress is a well-known trigger for migraine headaches. While we can't eliminate stress from our lives, there are certainly things we can learn to do to modify how we respond to stress. The fight or flight response describes how the body and brain first responds to the presence of danger or acute stress. With this, we see a surge in things like adrenaline and an excitation of the nervous system, resulting in a rapid heart rate and heightened state of arousal. A great resource to learn more about how stress affects the body is a book called "Why Zebras Don't Get Ulcers."
Learning some new stress management techniques may help diminish the frequency or intensity of your migraines. Consider practicing some basic breathing techniques or sign-up for more formal training in stress management. Some possible resources for that would include an 8 week Mindfulness-based Stress Reduction program or working individually with a pain psychologist or therapist.
There are alternative treatments to consider for the treatment of pain associated with conditions like rheumatoid arthritis. Fish oils seem to show a strong anti-inflammatory effect and can be considered to be an alternative to prescription NSAIDS based on some reports. A few other naturally occurring compounds to consider adding could include ginger and turmeric, either as supplements or in the diet. Both have pain-relieving and inflammation reducing properties.
Consulting with a Chinese medicine specialist would be another resource to try other alternative oral or topical agents. In addition to the herbs, acupuncture may be a potential pain-relieving and inflammation lowering treatment to consider. Recent studies have found exercise to be an important part of managing arthritis. While finding the right type of exercise can be challenging for somebody with painful RA, some options to consider may include tai chi, water aerobics, Pilates, and gentle yoga, but consult your physician before trying any of these.View Thread
Hi there and welcome! While trigger point injections can help painful muscle knots, there are other things that can be tried that you can discuss with your doctors. Physical therapists could try the following techniques on you problem:
Myofascial release: This is deep tissue work to loosen tight muscles.
Neuromuscular re-education: This would involve working on body mechanics and posture that might be aggravating the problem.
Therapeutic exercises: Retraining the right muscle groups may help reduce tension in others that are over exerting themselves.
Other treatments to consider include acupuncture, topical agents, and getting a foam roller or theracane to work out the muscles on your own at home. Muscles around the upper shoulders and neck frequently tense up when we are under stress, so considering employing some stress management skills like using exercise, breathing techniques, or meditation to help calm things down.View Thread
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