Pain Clinic?

[Sonic]

Hello All,

I lurked in this forum for a year or so before it went down last year, and I'm back again. Never had the courage to post until now.

My question is if you think I'm a candidate for a pain clinic?

I'm a 29 year old man, living and working in Canada. I broke my arm severely as a child and have a resulting 15 degree offset off my forearm, and a "gunstock" deformity as the orthopedic surgeon calls it. For a long time, this caused me no trouble. The deformity is unrepairable, but I'm told I'll need an elbow replacement "in the future".

I have somewhat constant arm pain after two failed ulnar nerve transpositions. On top of that, I have osteoarthritis and osteonecrosis in the elbow, as a result of the break. I have had recent NCV/EMG tests that show relatively normal function of the ulnar nerve. This doesn't explain why I still have pains that shot down the inside of the forarm into my pinky and ring fingers.

The orthopedic surgeon says that there is nothing further that he can do surgically other than an elbow replacement that obviously, I want to put off as long as possible.

My GP has tried NSAIDS, gabapentin, topamax, nortriptylline, Lyrica. I am currently only on Lyrica 150mg 3x a day, which gives some relief. But the pain persists. I'm quite sure that he has labeled me as a "drug seeker", and isn't that helpful when I talk to him about my pain. I think drug seeking for pain relief is much different from drug seeking for pleasure which is a distinction my Dr. doesn't seem to make. Anyways, I think it's a bit of a dead end street with him.

I have one more appointment with my Orthopedic Surgeon to go over the recent "normal" NCV/EMG tests. He will tell me again that there is nothing further that he can do surgically. Should I ask him for a referral to a pain clinic? Would he be in a position to refer me? Do you think I am a candidate? What would a pain clinic offer that my GP can't (or won't)?

Sorry this is so long, and thanks for reading this far. I would really appreciate your opinions on this.

Thanks,

Graham

[Mark N]

Graham, it sounds like you are ready for PM. You are right about not being a drug seeker if you are only trying to control your pain levels. If the pain is significantly affecting your life then a PM is definetly in order.

[BrokenBladder]

Graham, please don't give up and pursue the Pm route. You need some relief and this may be your golden chance.

[Sonic]

Hello Mark & Lisa,

Thank you both very much for reading my long post, and for your encouragement. I will certainly ask my Ortho. Surgeon for a referral, and I'll report back. I guess I see people with much more severe pain than mine, so I question whether or not I am a candidate, but yes, as Mark points out, it significantly affects my life. I can't pick up my baby daughter without enduring significant pain. The pain makes me grumpy and irritable most of the time around my wife and daughter. So I think getting some adequate pain control would make my life much better. Hopefully the surgeon will agree, and give me the referral.

Thanks,

Graham

[Diandra]

Hi Graham,
Yes, do seek out a pain mgmt. doc. I don't have the energy to read the responses and don't know if this has been said but, do remember that if this doc thinks you are drug seeking, he may pass this info onto the pain doctor, especially if all your records are being forwarded.

Also, in my experience, the younger a person is, the quicker they are to be labeled a drug seeker by non pm doctors. Just that old fashioned idea that pain goes with old age, not with young people(ignorant, yes...I know).

You deserve to have your pain taken seriously and treated. Perhaps ask on this forum for pain docs in your area.

I wish you the best,
Diandra

[suede]

Sonic, so sorry to hear of your pain and problem.
You have already gotten some good advice, I don't have much to add.
Basically wanted to say hi and welcome, glad you posted finally, just sorry you have the need.
When pain begins to interfere with the our quality of life then it is definitely time to seek PM. True when your young it seems that the Dr's are quicker to jump to the drug seeking line, but it isn't just the young.
Nerve pain is one of the hardest pains to control, I've been dealing with it for almost 8 yrs and have finally got it to where life is livable as long as I limit myself very strictly.
The sooner you start trying to get in to a PM Dr the better for you and your family.
Best of luck and keep us posted as to how it goes.
Linda

[Mark N]

I hope you are able to get the referrel as I know the Canadian system doesn't respond the same as our's does here in the states. You should be able to maintain a lower level of pain so that you can function better. I waited until late into my spinal journey and now I am paying the price. I just wonder howit would have been if I accepted PM earlier.

[Sonic]

Thanks everyone for making me feel welcome here, and for your advice. I appreciate it.

I really hope that my GP doesn't make me out to be a drug seeker to the pain clinic. I have never asked for any medication without first bringing in journal references showing some type of benefit with my particular issues. I have never asked for a narcotic, in fact, I have said that I would like to avoid narcotics. The only drug I have asked for that he has started to refuse, is zopiclone, which is the Canadian version of Ambien (similar class). The pain really causes insomnia a lot of the time, but I have had to try to learn to sleep without prescription sleep aids. I feel that he thinks I am a drug seeker, and consequently, I am under treated for my pain. Because of the huge shortage of Doctors in Canada, it is very difficult to find a new physician, and most would not be willing to take on a patient with a "chronic pain" diagnosis.

Should I bring this up with my GP, and challenge him if he agrees that he has labeled me a drug seeker? Will I be able to convince him that if I seek drugs, it's for symptom relief and not for pleasure?

And Mark, you are correct, even if I DO manage to get a referral, I face a one year wait to get into a pain clinic. But I don't anticipate that the pain will abate, so I guess I'll have to live with the wait.

Thanks,

Graham

[moi]

I live in Canada as well and go to a pain clinic in a University Hospital. I wish I had been directed there years ago, been going five years now. Since they specialize in pain and work with a multidisciplinary approach they are into research and have much to offer and how refreshing to actually discuss pain so openly and honestly.



There are people of all ages there. Since most have a wating list they go on a triage basis so get the referral from the doctor you trust the most and have him write as much as possible on your form, kindly moi

[Mark N]

I am glad moi responded to your post and you have some advice on how to make your system work. I would bring it up with my doctor, afterall if you are rejected by him you are in the same position you are now and will have to find another doctor that can work with you.

[Diandra]

Hi Graham,
Just a bit of advice. Don't ask for a particular drug as you did with the sleep aid. Just explain that your pain is so bad you cannot sleep and you have night after night of no sleep and you are exhausted, cannot function during the day because of it, cannot drive or you fall asleep doing important things like watching the kids or however it affects you.

Why do you think your doctor has labeled you a drug seeker? I think coming right out and asking without really strong evidence your doc thinks that is not a good idea.

I have a really good relationship with my pain doc and we had a discussion once about what would make him be suspicious of someone and he said, three things...one that the patient came to him without a referral and the pain could not be documented with tests (like a disc hernation, etc.), and two, they asked for specific drugs and three, that they lost or misplaced their drugs. Now this was my pain doc, not my primary care doc....it was my primary care doc who referred me because he said I needed more medication than he was comfortable prescribing.

The reason the discussion came up was because he was out of the office for an emergency once for my regular appt. and I had to see his NP and she was just brutally suspicious without reason and it seemed she suspected everyone of drug seeking and when I saw him next, I told him. I said it was degrading and humilitating to be treated that way and he needed to tell her to lighten up and I said I would never see her again. She did not last in the practice long and he said he would not suspect someone like me because I came with referral from my doc with yrs of records of documention of trying to treat the pain and the other reasons listed above.

It is awful it could take so long to get to a pain doctor in Canada. No wonder you are so concerned. I wish you the best,
Diandra

[CowBone Chris]

Hi there, I too am Canadian around the Hamilton Area and was referred to Chedoke/McMaster Pain Clinic where they offer to start, a 4 week program out of Chedoke. One of my treating physicians referred me to this program. He figured it would be of some help for sure but didnt really know all the details on my spinal issues. I think it was about 4 months and then I got in for the orientation appointment and then few days later did the assessment with a O.T. from the clinic. She advised me that it maybe a 2-3 months before I got. So I don't think that wait was out of line considering the list of people needing to get in and getting in. I was quite surprised actually of how well it is all set up and how helpful they really are.
After I opted out of the program, they followed up with me in a day to let me know they were making me an appointment to see the doctor there anyways to see what if anything they could help me with and I could go from there, even offering me one on one if needed. I was again very impressed with this, didnt even know they could do that, so it shows me the system is very good at least in my experience.
I will be going to that appointment of course with my list of things that I could use help with and get some expert consultation with my medications I am on too and see if I am taking them to get the best benefit.

So all in all, see if you can get in, its worth the wait and they will really cover the complete realm of living with pain. They won't get rid of it, they expressed that over and over again, but they do show you how to minimize suffering and how to cope and how to live a better quality of life.

Good luck
your spiney friend,
CowBone Chris