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Pain management was a total waste!
#234506 06/04/12 09:18 PM
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I really don't know why I keep going to doctors! I keep wasting my time and money on incompetent idiots! I am so angry right now. (Can you tell?)

I had my initial and last visit with a pain management clinic. I had called ahead of time and asked if they just dealt with pain medications or offered a variety of other non-narcotic treatment options. They said they offered a multidisciplinary approach.

One month later, bringing multiple doctors records (as requested), and completing over 15 pages of detailed information about my condition, pain levels, ability to function, and past treatments....I show up at my appointment.

After less than 10 minutes with the physician's assistant, she took all my records to the pain doctor in another room and came back 5 minutes later. Results: gave me suggestions for two possible medications for my rheumatologist to provide me. I asked about any other treatment options. They said couldn't provide me with any. NOTHING! I didn't need to add yet another specialist to my list of caretakers. (Yes! She actually said that.) She said my rheumy was providing an excellent level of pain management. (I had previously told her my rheumy had recommended I work with a pain management specialist!)

I asked if the medications they were recommending were narcotics. NO. I asked if I was supposed to take one of them while I was still using oxycodone. YES. I asked if either one would cause issues with my adrenal insufficiency (a previous problem I had already mentioned to her and was in my records). NO.

Well, the meds turned out to be Ultram ER and a Butrans patch. Butrans is a narcotic with clear contraindications for people with adrenal insufficiency. Ultram ER raised THREE red flags with my other current medications, including my oxycodone, according to Drugs.com

I can't believe I went through all that, drove an hour to get there, and ended up with not just less than nothing - but with potentially dangerous medication recommendations! And this is after I had to deal with an idiot of an endocrinologist just last month!

Both of these doctors were recommended to me by another doctor. What on earth is going on that I can't get decent medical care??? I'm going crazy! It's hard enough to deal with this horrible disease without dealing with lousy doctors to boot!

I have incompetent doctors on one hand, and friends that keep pushing diets, Prana therapy, and massage as my "cure". I'm in tears again, with frustration and depression. I keep hoping to make some progress, and I'm getting nowhere!


Psoriatic spondylitis, became severe within 3 years; on disability. Single, age 57. Failed Humira, Remicade, and methotrexate. Can't take NSAIDS or opioid pain meds. Also have adrenal insufficiency and thyroid issues.
Re: Pain management was a total waste!
Sundance #234507 06/04/12 09:40 PM
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So sorry to hear of all you are going through in addition to your pain. As far as the patch you mentioned, my husband suffers from Barter's Syndrome which compromises the kidneys and his rhuematologist prescribed a patch form of diclofenac for his joint pain that was not supposed to be hard on the kidneys like diclofenac.

Re: Pain management was a total waste!
Sundance #234508 06/04/12 10:02 PM
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sweet mother of god. that is unutterably horrific. follow up with your insurance to make sure they don't bill for an MD visit since you never even saw one!!!

it is true that topical NSAIDs, both patch and gel/creams, only get into the bloodstream at 5% the rate of oral NSAIDs; but that doesn't mean the same is true for opiates. To be honest you should assume it is NOT true until you can get confirmation from a competent MD or pharmacist.

The fact that the PA told you the meds were not narcotics is very very scary. You should give some thought to running this past your state medical board. They could really hurt people!!

I am so, so sorry. What a tremendous letdown after all you went through to get to that point frown


Jen, 42, happy partner of James and Moma to Evan, 14, & Lucy, 12.5 (Crohn's dx @ age 3; on Remicade since April 2010.) I take piroxicam, Flexeril, & Nucynta ER nightly. 3 anti-TNFs didn't pan out for me.

"Science is the father of knowledge, but opinion breeds ignorance." -- Hippocrates
Re: Pain management was a total waste!
Sundance #234509 06/04/12 10:11 PM
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I'm so sorry you had to go through all that for nothing. I'd second Jen's suggestion that you make a formal complaint - that could have caused big problems if you had gone ahead with their recommendations. I'd also do more research about the patches. As Jen says, it is true that NSAIDs are much gentler on the system in patch form than oral, but the same isn't necessarily true of other drugs. It all depends on how they are absorbed and whether they end up in your blood stream or just in tissues. Some things can get into your blood stream when they start off on the skin.


Cauda equina type neurogenic bladder problems. Coeliac disease. Sicca syndrome. Ataxic gait and use crutches. Non-specific gut problems. Current treatment: Low dose naltrexone, low starch diet (Guts shredded by NSAIDs. Previously diclofenac worked well, not eligible for anti-tnfs, hypersensitivity to SSZ). Also short bursts of pred for bad flares
Re: Pain management was a total waste!
Sundance #234510 06/04/12 10:11 PM
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Sorry that was such a disappointment. I hope you can find real help somewhere else.


Sharon, 38 year old mom to a 5 year old and 3 year old twins. Diagnosed Undifferentiated Spondylitis 04/12. HLA-B27 negative. Currently switching from Gabapentin and Cymbalta to Savella; also taking Humira, Trazadone, Cyclobenzaprene, Vit D and Tramadol.
Re: Pain management was a total waste!
Sundance #234511 06/04/12 10:13 PM
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Sundance,

What an extremely frustrating experience! I am so sorry you went through this. I'm sure the last thing you want to think about right now is visiting yet another doctor, but is there another pain management doc in your area?

I hope you find some relief soon.



41 y/o female, diagnosed RA 2009, sacroiliitis, peripheral arthritis, most major joints involved, HLA-B27- but suspect AS or spondylitis, Raynaud's, GERD, currently taking Orencia sub-Q, Mtx via injection, citalopram, omeprazole, tramadol, Cyclobenzaprine.


2012 - diagnosed with colitis and iritis and seronegative arthritis.

Failed - Enbrel (stopped working after 10 months), Humira (no effect) and Remicade (failed after two years).
Re: Pain management was a total waste!
Sundance #234514 06/04/12 10:42 PM
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The way I understand pain patches:

NSAID patches are designed to be applied directly above the source of pain. Works best when the inflamed area is close to the skin (not under thick layers of muscle or fat). Most of it does not get into the bloodstream, but remains in the tissues close to the patch.

Narcotic pain patches are applied to certain recommended areas - usually chest, upper arms, upper back, etc. Often not close to areas that are hurting. The medication is designed to travel through the bloodstream to other areas of the body.

That's not my issue with the narcotic pain patch. I had a major adrenal crisis the last time I was on a narcotic pain patch. It was a fairly mild dose of 25 mcg of fentanyl. My family doctor does NOT recommend I try any other narcotic pain patches, and I absolutely agree. I'm also likely to have a similar reaction to any extended release narcotics. That's why I asked both 1) if either of these meds were a narcotic and 2) if they could cause adrenal issues. I was very clear about my past experience.

This is WHY I was looking for alternative pain control methods. I can't take enough narcotics to control my pain very well.


Psoriatic spondylitis, became severe within 3 years; on disability. Single, age 57. Failed Humira, Remicade, and methotrexate. Can't take NSAIDS or opioid pain meds. Also have adrenal insufficiency and thyroid issues.
Re: Pain management was a total waste!
Sundance #234525 06/05/12 02:04 AM
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yeah, clearly the PA did not understand the subtleties. what a shame they could not find the time for the MD to talk with you... a waste of your time and effort and they lost a potential patient, not to mention that you are going to bad-mouth them whenever you get a chance (well, at least, I would!!!)


Jen, 42, happy partner of James and Moma to Evan, 14, & Lucy, 12.5 (Crohn's dx @ age 3; on Remicade since April 2010.) I take piroxicam, Flexeril, & Nucynta ER nightly. 3 anti-TNFs didn't pan out for me.

"Science is the father of knowledge, but opinion breeds ignorance." -- Hippocrates
Re: Pain management was a total waste!
Sundance #234542 06/05/12 09:56 AM
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I'm sorry things didn't go well. It's absolutely terrible that you went through all that for nothing. What a waste of time & energy, both of which are always in short supply. I agree that you should make a complaint. I'd call your insurance co. too, & report them for not doing anything to help & recommending contraindicated & possibly dangerous meds. Absolutely ridiculous!


-Jenn. SAHM with 4 kids. Diagnosed with AS('08) Psoriasis, probable Sjogrens(won't do lip biopsy), Fibromyalgia, Chiari Malformation, PCOS, endometriosis, diabetes(type 1), metabolic syndrome, mild hypothyroidism...
Remicade & MTX.

*I am in no way associated with the medical profession other than doing my best to keep them in business. Any advice I give is purely my own opinion and should not be substituted for qualified professional care.
Re: Pain management was a total waste!
Sundance #234543 06/05/12 12:00 PM
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It is truly a tragedy that this is the type of care (or lack, thereof) that patients have to endure. Was this a pain clinic or was he actually a pain management doctor? Also, is he one that specializes in anesthesiology? I used to see a pain management doctor, but he was a physiatrist as opposed to just a regular pain management doc. That is what you might want to look into. And one who is also an anesthesiologist, as they can also do injections. My pain management doc had known from our first encounter that I did not want narcotics, and never once did they offer them to me.

I can definitely understand your frustration. It's like you are caught between a rock and a hard place...damned if you do; damned if you don't.

(((hugs))) I hope that you are able to find a better doctor than this...and one who will actually provide you with medical care other than just pushing more narcotics at you. And I second what Jen said, call the insurance and make sure it is billed correctly.


Kim - age 33, married with 3 children
DX: Psoriatic Arthritis, HLA B27+
Meds: Otezla, Naproxen PRN, Prednisone PRN
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