Pain Management Doctor (When to see a PM doctor and what is a PM doctor?)

[Sara]

Hi,

I was wondering if anyone could tell when you should see a pain management doctor? And, are they better at dealing with cronic pain then a primary care doctor? I currently had Sacroiliac Joint Dysfunction and I am given Tramadol which helps the pain but doesn't make it go away and sometimes, it doesn't help at all.
My doctor told me that I would have to have sacroiliac joint fusion. Should I wait until after the surgery to request a PM doctor or prior to?
Any advise would be appreciated.

Thank you and have a great weekend.

[KBear]

Most primary care doctors will only prescribe for around 6 months and then refer you out (at least this has been my experience.) I think this is pretty common, because a) they realize that you aren't improving and are going to need more treatment and/or b) with all the drug dealing doctors out there, they don't want to fall into that group. Now where they refer you to depends... For awhile I saw a doctor who was an anesthiologist, but he handled all my medications, did the injections, and coordinated all my therapy. The next doctor's office I went to was basically the same. Not until they felt I had failed conservative therapy was I referred to a true pain management doctor. When I called to find one I asked for one who would take care of my medications and not require more injections, therapy, etc. (I had tried it all, spent tons of money trying it and it didn't work.) Most back doctors will treat your pain as long as you are doing all these other treatments, which don't get me wrong are good treatments; but obviously weren't working for me. My pain management doctor did tell me about surgery (which I had no idea was an option for me); but he also would have treated me if I had decided against it.

A good pain management doctor is priceless, they handle it all. They are able to give you non narcotic medication that can help with the pain, in addition to the narcotic. They know what can and can not be mixed and how to make the best plan for you. After surgery, I saw my pain management doctor for medication and not the surgeon, which I much preferred, since he knew me and my case. The surgeon acted as if I should be doing great at 6 weeks out and need no medication. The pain management doctor understood the reality of it and treated me until my pain was gone (18 months post op in my case) I would definitely ask around for referrals and make sure you find a true pain management doctor, where they aren't just treating you and doing unnecessary treatment to make a buck (which sadly I think a lot do.)
Good Luck,
Kathy

[Sara]

Hi Kathy,

Thank you for the response. It cleared up a lot of the questions I had regarding this. I ended up having to go to Urgent care last night because the pain got so intense and I am not getting pain on the left in addition to the right side. I'll speak to my primary care doctor and ask him to recommend me to a pain management specialist. How can you tell if the doctor is a "true PM doctor"? Do you google him and check what king of doctor he is?
Thank you

[KBear]

Hi Kathy,

Thank you for the response. It cleared up a lot of the questions I had regarding this. I ended up having to go to Urgent care last night because the pain got so intense and I am not getting pain on the left in addition to the right side. I'll speak to my primary care doctor and ask him to recommend me to a pain management specialist. How can you tell if the doctor is a "true PM doctor"? Do you google him and check what king of doctor he is?
Thank you

I called and asked. It took me calling several offices to find one with a real pm dr.

[Cindylou]

Hi,

I was wondering if anyone could tell when you should see a pain management doctor? And, are they better at dealing with cronic pain then a primary care doctor? I currently had Sacroiliac Joint Dysfunction and I am given Tramadol which helps the pain but doesn't make it go away and sometimes, it doesn't help at all.
My doctor told me that I would have to have sacroiliac joint fusion. Should I wait until after the surgery to request a PM doctor or prior to?
Any advise would be appreciated.

Thank you and have a great weekend.

Yes, definitely ask for a referral to a pain management doctor. My primary care wouldn't dose out ANY pain meds, period. And I respect that, so you definitely want an exceptional pain management doctor on your team. And as Kathy said, seek one out before your surgery, so you'll have things in place. You can also just ask a doctor you are interviewing, what his background in pain management is. Many, not all, pain clinics have their specialty written in the name of their facility. ie: Twin Cities Pain Management Center (TWPC), that type of thing. But you can and should ask the doctor how long he has been practicing medicine, and how long has pain management been his speciality, or has it always been his speciality.....that type of thing. Good Luck! Cindylou

[Shebo]

I am dealing with this same exact thing. I am certainly confused about the Pain Management. I was sent to the PM by my surgeon because he doesn't prescribe any meds after surgery. This is the first PM I have ever seen.

I have had two injections with no relief. Now she wants to do a third. I have told her that they haven't worked and I don't see the need. She calmly explained to me that now they know where to inject and the others were just for diagnostic reasons. This just doesn't seem right. I am trying to find another PM but when I call to make an appt they act weird when I tell them I am with a PM. Then they say to send my records and they will contact me. Anyway, Pain Management is in the name of her company but she is an anesthesiologist.

So what is a real Pain Manager's credentials?

[Justin]

I am dealing with this same exact thing. I am certainly confused about the Pain Management. I was sent to the PM by my surgeon because he doesn't prescribe any meds after surgery. This is the first PM I have ever seen.

I have had two injections with no relief. Now she wants to do a third. I have told her that they haven't worked and I don't see the need. She calmly explained to me that now they know where to inject and the others were just for diagnostic reasons. This just doesn't seem right. I am trying to find another PM but when I call to make an appt they act weird when I tell them I am with a PM. Then they say to send my records and they will contact me. Anyway, Pain Management is in the name of her company but she is an anesthesiologist.

So what is a real Pain Manager's credentials?

Typically, injections are done in a series of three. There is data to support that the series of three is not really needed and many insurance companies are not paying for the series anymore. Anyway, it it true that some injections are done for diagnostic purposes. Also, not all injections are the same. The approach and where they are ultimately injecting can be very different with each injection.

I'll explain the field of Pain Management, as there seems to be some confusion which is understandable.

Pain Medicine is a fellowship (a subspecialty) meaning advanced training after a physician completes a residency. There are 4 "paths" to pain medicine:

• Anesthesiology
• Physical Medicine and Rehabilitation
• Neurology
• Psychiatry (rare)

Thus, the majority of Pain Medicine docs are anesthesiologists with subspecialty training (a fellowship) in Pain Medicine.

I hope this helps.

[Justin]

Hi,

I was wondering if anyone could tell when you should see a pain management doctor? And, are they better at dealing with cronic pain then a primary care doctor? I currently had Sacroiliac Joint Dysfunction and I am given Tramadol which helps the pain but doesn't make it go away and sometimes, it doesn't help at all.
My doctor told me that I would have to have sacroiliac joint fusion. Should I wait until after the surgery to request a PM doctor or prior to?
Any advise would be appreciated.

Thank you and have a great weekend.

You should see a pain management doctor when your pain transitions from an acute process (less than 6 months) to a chronic one (6 months and greater).

Primary care doctors are not pain medicine doctors. Yes, some primary care docs prescribe opioids (narcotics) and non-narcotic medications to treat pain. Chronic pain patients should be referred out to a Pain Medicine doctor. These doctors are described in my post above. Note, primary care physicians do not have the subspecialty training that Pain Medicine physicians have.

You should be working with a physician that specializes in chronic pain. This will be key, especially post-op so that your pain can be adequately addressed. Also, it is best to have a pain doc involved before your surgery so that there is a smooth transition from pre-op --> surgery --> post-op.

Goodluck.

[Shebo]

Justin:

Thank you for helping to clear up the PM mystery. As you know, it can all be so confusing.