The absurdness of some dr's offices...

[laid up doc]

So I had a wonderful pain dr where I used to live... hooked me up with trigger point injections often even w/o a clear appointment, b/c it's so quick. Was able to also have dry needling done b y my PT for my very persistent myofascial pain - that i now know i only have when my bad disc is mad... it went away after my biacuplasty and didn't come back for a few mo after my re-injury.

Anyway... moved to a different state, where I had already seen an nsurg and have a PT now, but dry needling not w/in scope of practice of PT's here. No problem, I thought... this neurosurg clinic also has pain docs.

Not so fast my friend - I can't go see a pain doc in their clinic w/o seeing the nsurg again. not only can i not have him do my surg b/c Aetna won't cover fusion, but his next appt isn't til the 2nd week of October. Here I am barely able to function, and they refuse to help me at all. Nurse talked to the nsurg and they won't budge.

Guess I'll just have to see another pain dr somewhere else... I told the nurse to tell the nsurg where to shove their "policy".... same group btw that gave me all kinds of interference on getting a 2nd opinion from another surgeon in the group, THAT WAS REQUESTED BY THE FIRST SURGEON!

this is supposedly THE spine group in a large city in the southeast. i explained to the nurse in detail my situation - that i had just moved, in severe pain, narcs don't help.... to no avail. i'm so angry i'm about to see red and spit nails.

[MeggieLynn]

I've been to multiple pain clinics and they all seem to have their own very strict rules re:treatment philosophies - They seem to rarely take into account what the patient feels is best for themselves and they insist on you following their program.

I had a similiar situation in the orthopedic office that did my SI Joint Injections. They were done by an anesthesia trained MD who I could tell was extremely skilled and knowledgable. I asked him if there was anything he could do for some of my thoracic outlet symptoms (like a block of some kind). "No, no you have to go back to the surgeon to get an order." Very frustrating especially when you have to wait a month to get into to see the surgeon. Had enough appointments coming and going at that time to see various MD's so I gave up on that.

Try not to get too upset by it - it will make the triggerpoints worse - but of course you know that. There are plenty of pain management practices out there that are hungry for the extra revenue that injections bring in. Maybe a smaller practice (less corporate) could get you in quicker and be more accommodating given your circumstances and you're need for (relative) comfort while traveling. Congratulations, by the way, on the relatively good outcome for the metals testing. You must be both elated and relieved.

ML

[annapurna]

YYou might consider trying a natropath or similar outside of the normal system type doc on a self pay basis for the dry needling. For that matter, accupunture might buy a little functionality and time.

Sorry about the situation. Laura lost out on a handful of docs through the years because the legal situatio in Utah made them unwillign to even consider treating patients here. We even corresponded with a radiologist who moved east for a few months because he was the only one willing to discuss the conditions of her facets.

[laid up doc]

I am VERY relieved about the testing - and glad that the LTT detected my nickel allergy despite the dermatologist insisting that the patch testing doesn't miss nickel reactions.... and i have an obvious nickel allergy by history.

i am fortunate to have a very good friend (practically a brother) who is a pain dr about an hr away - he will help me out, but i hate to have to ask him (esp since it's my BUTT!!!). i will find someone else to see regularly for ethical reasons, but it's good to be a dr and have most of your friends be dr's sometimes....

[MeggieLynn]

You can also do accupressure on youself in the places you can reach. In 2009 I had a lot of triggerpoints in my lower spine/butt. The triggerpoints always came back after the injections within a few days. I found I could relieve them again by pressing really hard on them for 1-2 minutes and then massaging the area. Often times they were gone the next morning, after sleeping overnight. I did this every week or so and they were eventually "permanently" gone after 10 months. Unfortunately, I can feel some of them coming back with the SI Joint problems.

[Harrison]

ML, yes, good point.

Way back in 2003-04-05, I used the Theracane often to apply pressure to hard-to-access points of tension....very effective indeed. See Amazon or Theracane.com. I recall laying down and digging that puppy into my glutes and lower back. It's amazing I didn't pop an organ or a joint!

Haven't used it in years, since I've been doing all the other "inside-out" healing therapies I wish I learned about decades ago...

LUD, what's the latest on your pain mgt? Have you tried "everything" else?

[laid up doc]

I do my own trigger point work w/ a tennis ball - works well and cheap as heck! the most stubborn ones though, need a needle in 'em.

Harrison - what do you mean by "everything" else? i'm on a few pain adjuncts already - cymbalta, zanaflex, trazodone at bedtime. flexeril/valium prn. narcs don't agree w/ me. i'm trying to get my pain under control enough that i can do some walking and pool exercise before surgery. right now, i limp and barely sleep. the move definitely did a number on me - and i haven't even unpacked the kitchen!

[Harrison]

Hi LUD,

"everything" else" = all the non-drug remedies. E.g., functional, integrative, alternative therapies. Your body is absorbing so many drugs. Since you are doc, do you have "better" access to finding a DO, NP or another person that can help you ween off these drugs which are marginally effective in pain management -- and not helping you heal?

Your ideas involving water exercise are in accordance to better outcomes from many in this community, especially preoperatively. This is tough when you have a localized disease in your spine, but again, so many have done this with (what would appear) to be better post-op results.

Hope you feel better in the days ahead!

[laid up doc]

Harrison,

i already took myself off lyrica... i truly cannot sleep w/o a cocktail of meds. when i don't get decent rest, my pain is worse and my mood is, well... sublimely bad.

i was off nearly all of them earlier this year after the biacuplasty, and before the MVA. it's been a repeat downward spiral ever since. i do think that what i am on helps, but nothing can cure this annular tear that's recurred now multiple times.

my understanding of my bad disc is that it is isolated - even after the MVA the rest of my lumbar spine is remarkably healthy. i have been doing PT twice a week, including dry needling and lots of soft tissue work. my spine flexibility is off the chart (in a good way) despite my issues - main problems i'm having are muscular and i have tight hamstrings and achilles. i just started limping again in the last month or so.

i seem to be having a bad muscle pain flare from my recent move and many hrs in the car. i also had to just grin and bear an awful lot of pain the last couple of months to work as much as i could before i stopped working to move and have surgery.

i'm not the biggest believer in alternative medication when there is a proven physiologic/mechanical cause for symptoms - i do get massages and believe a lot in that. at this point, imho, paying out of pocket for much more than that is kind of a waste of my limited $$.

will start my pool workouts tomorrow... have had storms on and off last few days and if i got all ready to swim and it thundered... i probably would have had a meltdown. i have a friend who is a pain dr here where i just relocated, who is going to help me either himself or by facilitating an appt w/ one of his partners or friends. in that way, i am very fortunate... i have good friends (like most of us, i have lost some non-true friends along the way) and a lot of them are fellow dr's, PT's, pharmacists, etc.

[laid up doc]

Am happy to update that I got in w/ a pain doc last week and got my trigger points injected.... with decent muscle pain and tightness relief. The doc was very impressed w/ my thorough documentation of my treatment since my initial injury in 2006 (it's a 3 page word document), agreed I had done everything I could to avoid surgery, and even endorsed my plan to have an M6L overseas.

This pain group will follow me post-op as far as meds, further tp work, and whatever I need as far as xrays post-op. The wait was awful and I felt like an alien in the waiting room (lots of people I would nail as seekers, obese people in wheelchairs, smokers, everyone looked over 50)... but I got what I needed. I really hope to work my way out of needing a pain doc by 3-4 months post-op. I know that my myofascial pain and biomechanical issues won't be fixed immediately post-op, but based on my biacuplasty experience... I can get relief from those issues when my disc isn't hurting.