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Chronic Medical Problem/Pain: What next?
Omnicron9999
Registered User regular
Registered User regular
I will try to sum up my problem as succinctly as possible, but this is going to get pretty long, so I apologize in advance.
Last summer I spent about 3 weeks in the hospital with a very severe case of pancreatitis. My doctors at the time were not 100% sure as to the cause, but they pretty much settled on it being alcohol related. It didn't matter to any of them that I really didn't drink all that much, but, being a college student, they seemed to assume that I was lying about my drinking habits. I did drink regularly, but not to the same degree as many of my friends, and girlfriend at the time. In any case, the cause doesn't really matter, the treatment is the same regardless. I was also willing to consider the fact that my body could not handle alcohol the same way other people's does.
I was also told that I had a rather large pseudocyst on my pancreas, but it was benign, so they were content to leave it there.
In the past year, I have had a number of bouts with abdominal pain, back pain, and just other unpleasantness. I went to several doctors, with various diagnoses. Lingering chronic pancreatitis, back spasms, etc.
Finally at the beginning of this summer I went to the ER with severe abdominal pain. It was revealed that the pseudocyst on my pancreas had grown even larger (about the size of a grapefruit). They also saw some indication of gall stones. It is very possible that these gall stones have been causing the problems with my pancreas the entire time. Also, they're pretty sure that the size of the cyst has been causing all of my intermittent problems. They decide to remove my gall bladder and drain the cyst on my pancreas.
Everything went fine, and I was virtually pain free for a few months. Starting about the second or third week in August, I started feeling general abdominal pain almost 100% of the time. Every once in a while, I would have extremely intense pain, right about where my gallbladder used to be. This was completely incapacitating, and I have had to go to the ER every time.
My first reaction was to see my surgeon, and my GI doctor. The surgeon told me to just keep following up with the GI, because there is nothing she can do for me. The GI isn't really sure what is wrong with me. Throughout this most recent pain, I have had numerous ultrasounds, CT scans, and MRIs. They haven't shown anything conclusive. I am currently scheduled for an endoscopic ultrasound next week.
My question isn't really about the medicine involved, although any input there would be appreciated. My question is about pain relief. No one wants to prescribe me any medication for pain. My GI said that I needed something for pain, but he thought that a GP would be in a better position to monitor that. So a few weeks ago I finally got a GP, however, he didn't seem to think that I should be seeing him. Before I even told him my medical history, he straight out told me that he wouldn't prescribe any pain medication, unless he saw me in severe pain.
Ultimately he just told me that I should be just seeing my GI.
In the mean time, I make a trip to the ER probably once every two weeks or so. Simply because my pain flares up so bad that I can't even function. I'm not kidding, I can hardly even walk when I get one of these attacks. With the general abdominal pain that is around all of the time, I can usually bear it, if I am just sitting down and not moving. This is never the case, I am taking 5 courses this semester, and I have a job working in a lab (i.e. standing all day).
If I do happen to have a few pain pills around (occasionally they will write me a script for 10 or so in the ER) it becomes a choice between sleeping or actually making it to class or doing whatever else I need to do. So far, I actually haven't missed much class or work, but that doesn't seem like it will last.
Also, I feel like I might be getting a reputation in the ER for just seeking pain pills. One DR who saw me accused me of this, and refused to listen to anything I had to say. I'm pretty sure she made a note of this in my chart.
I just don't know what I should be doing in this situation. It is incredibly frustrating. And, yes I absolutely understand that pain medication is not the long term solution, nor do I want it to be. This is why I am still proceeding with all of my doctors advice and tests. I also understand why doctors are reluctant to give it out, but I feel like I am one of the cases where it is actually warranted.
tl;dr: I legitimately need pain medication, but no one wants to give it to me.
Thanks for any advice!
Last summer I spent about 3 weeks in the hospital with a very severe case of pancreatitis. My doctors at the time were not 100% sure as to the cause, but they pretty much settled on it being alcohol related. It didn't matter to any of them that I really didn't drink all that much, but, being a college student, they seemed to assume that I was lying about my drinking habits. I did drink regularly, but not to the same degree as many of my friends, and girlfriend at the time. In any case, the cause doesn't really matter, the treatment is the same regardless. I was also willing to consider the fact that my body could not handle alcohol the same way other people's does.
I was also told that I had a rather large pseudocyst on my pancreas, but it was benign, so they were content to leave it there.
In the past year, I have had a number of bouts with abdominal pain, back pain, and just other unpleasantness. I went to several doctors, with various diagnoses. Lingering chronic pancreatitis, back spasms, etc.
Finally at the beginning of this summer I went to the ER with severe abdominal pain. It was revealed that the pseudocyst on my pancreas had grown even larger (about the size of a grapefruit). They also saw some indication of gall stones. It is very possible that these gall stones have been causing the problems with my pancreas the entire time. Also, they're pretty sure that the size of the cyst has been causing all of my intermittent problems. They decide to remove my gall bladder and drain the cyst on my pancreas.
Everything went fine, and I was virtually pain free for a few months. Starting about the second or third week in August, I started feeling general abdominal pain almost 100% of the time. Every once in a while, I would have extremely intense pain, right about where my gallbladder used to be. This was completely incapacitating, and I have had to go to the ER every time.
My first reaction was to see my surgeon, and my GI doctor. The surgeon told me to just keep following up with the GI, because there is nothing she can do for me. The GI isn't really sure what is wrong with me. Throughout this most recent pain, I have had numerous ultrasounds, CT scans, and MRIs. They haven't shown anything conclusive. I am currently scheduled for an endoscopic ultrasound next week.
My question isn't really about the medicine involved, although any input there would be appreciated. My question is about pain relief. No one wants to prescribe me any medication for pain. My GI said that I needed something for pain, but he thought that a GP would be in a better position to monitor that. So a few weeks ago I finally got a GP, however, he didn't seem to think that I should be seeing him. Before I even told him my medical history, he straight out told me that he wouldn't prescribe any pain medication, unless he saw me in severe pain.
Ultimately he just told me that I should be just seeing my GI.
In the mean time, I make a trip to the ER probably once every two weeks or so. Simply because my pain flares up so bad that I can't even function. I'm not kidding, I can hardly even walk when I get one of these attacks. With the general abdominal pain that is around all of the time, I can usually bear it, if I am just sitting down and not moving. This is never the case, I am taking 5 courses this semester, and I have a job working in a lab (i.e. standing all day).
If I do happen to have a few pain pills around (occasionally they will write me a script for 10 or so in the ER) it becomes a choice between sleeping or actually making it to class or doing whatever else I need to do. So far, I actually haven't missed much class or work, but that doesn't seem like it will last.
Also, I feel like I might be getting a reputation in the ER for just seeking pain pills. One DR who saw me accused me of this, and refused to listen to anything I had to say. I'm pretty sure she made a note of this in my chart.
I just don't know what I should be doing in this situation. It is incredibly frustrating. And, yes I absolutely understand that pain medication is not the long term solution, nor do I want it to be. This is why I am still proceeding with all of my doctors advice and tests. I also understand why doctors are reluctant to give it out, but I feel like I am one of the cases where it is actually warranted.
tl;dr: I legitimately need pain medication, but no one wants to give it to me.
Thanks for any advice!
Omnicron9999 on
0
Posts
I cannot give you advice on doctor shopping even if you are legitimate. This is the problem with subversive behavior concerning controlled narcotics used for medicinal purposes. The bad apples ruin it for those in need and even those in need must resort to doctor shopping even if its for legitimate purposes. It creates a nasty gray area and can have long lasting negative connotations for the person coming from the doctors whose help that person needs the most.
Shogun Streams Vidya
Sorry, I wasn't exactly clear on the whole cyst thing. The cyst is actually a pancreatic pseudocyst. It is actually made up of pancreatic tissue, unlike a normal cyst. In order to remove it, pancreatic tissue would have to be taken out, which is to be avoided. Draining it should eliminate all of the problems though.
The pain that I am having now is in the area of where my gallbladder used to be.
I agree completely that there should be some cause for this pain, and I would like that cause to be treated. However, I would also like to be free of pain in the meantime.
Also, depending on what state you live in you have the right to examine your record and to amend it, if someone has noted that they think you're a junkie and it turns out you have a serious issue then you can have that recorded so you aren't discriminated against in the future.
If your GI doctor says you need medicine for pain then they better well give you some damn medicine. They don't have to necessarily give you CII's but something at least. You should get your GI doc to call your PCP so they can explain the situation. Whoever performed/recommended this procedure is responsible not only for a successful surgery, but also for the after effects. Your quality of life has obviously not improved so your doctor needs to pursue an alternate therapy.
You are in an awful situation here and unfortunately you will get a reputation with the ED. The pharmacy you go to will probably also notice a trend. There are doctors out there that specialize in pain management so you may want to go that route. I hope they can find the cause for your discomfort.
This sums things up pretty well. It would be extremely difficult to get a new GP to prescribe heavy duty pain meds for pain they don't see you experiencing, jaded or otherwise, and that they are told is coming from something they cannot verify themselves (that is to say, while he could verify the history of abdominal issues, theoretically they should be resolved between the removed gallbladder and drained cyst - leaving no real explanation for or apparent cause of your current pain).
Ok, so just checked with my wife, who is an ICU doc. Her number one recommendation is getting in with a pain clinic specialist asap - in particular one who started as an anesthesiologist if possible (as opposed to someone with a background in physical medicine and rehab, say, but take what you can get if options are sparse). She said that pancreatitis pain that severe (I know you said the pain is in the area where the gallbladder used to be, but based on the details here she thought the pancreas would be the far more likely source of pain at this point) tends to be chronic and that the need for pain medication usually only increases over time - and that this is likely the biggest reason a GP who doesn't know you refuses to get involved, and also why the GI thinks another doctor would be more appropriate for the pain medication prescription. That sort of long term chronic pain management isn't something a GI specialist would normally be involved in, unfortunately.
Good luck with everything, and try to get in to see a pain management doc as soon as possible. If you're having trouble getting in to see one soon be sure to explain to their gatekeepers that you've had to make multiple ER visits due to pain since your surgery, and that your GI doc believes pain management is definitely necessary but doesn't want to get involved in that aspect of your treatment, leaving you in desperate need of pain management help as soon as possible.
[SIGPIC][/SIGPIC]
Sweet jebus ignore everything in this post, OP.
Well, make of the marijuana suggestion what you will. Beyond that, going after tramadol without a prescription is a bad, bad idea for obvious reasons. Also, Tramadol is an opioid, yes, but far less effective at pain relief than the more serious opiates most people think of (it also has much less of a drowsiness inducing effect than the typical opiate painkillers, and the only way I have ever heard of it being used for sleep is off-label treatment of restless leg syndrome, not general sleep issues). A pain doc might start you on tramadol in the hopes that it will be sufficient, but from my own current personal use I can tell you that it has been only mildly effective at relieving pain from a pinched nerve caused by two herniated discs. It never relieves the pain 100%, and on very bad days I have hit the max dose with almost no relief noticed whatsoever. I would be surprised if it proved strong enough for what you are experiencing.
Oh, and tramadol is not an SSRI. It is an SNRI, and there are potential interaction issues with concurrent use of an SSRI, but it is not an SSRI itself.
The second to last time that I had an episode I called my GP and he eventually said to call my GI, the GI then said to go to the ER.
The most recent time happened on a Saturday night, so waiting until Monday morning would have been unbearable.
Good to know about the record amendment though, I'm gonna look into that.
Thanks everyone for all of the good advice! Even to the weed guy...it is certainly a route I didn't consider :P
[SIGPIC][/SIGPIC]
Heh, my mistake on the sleep issue. Everything else stands. If you can show me a legal way to get a tramadol prescription online, I'll eat my hat.
[SIGPIC][/SIGPIC]
Welcome to the war on drugs. You are an acceptable loss. How do you get around it? You don't, citizen. Grit your teeth and move along.
Pain itself just isn't enough to justify medication. You have to be in enough pain, for a long enough period of time, that a doctor can justify your prescription along with every other pain drug script for every other patient they've ever written to state investigators. Doctors that are seen as too giving with pain meds can lose their license to practice or end up in jail. It's legally a very gray area and many doctors are reluctant to prescribe anything for any reason.
Going to the ER for pain meds is a flag for 'addict' behavior (as you've seen) and trying to switch doctors may also be a crime (doctor shopping) depending on how law enforcement is feeling that day. You can try being seen by a pain management specialist, but it usually takes time and money to get into those programs. But their goal is to get people off pain meds and they will try hard to get you there. Notice that's not the same as "Pain free" by a long shot. They told me up front that my pain 'may increase temporarily' at the smae time they stopped my scripts. Lots of them are combined doctors with counseling. I don't know that the physical therapy stuff would matter for you. Still, it's your best shot if you can afford it.
Sorry that doesn't really answer your question. I dealt with the same stuff for over a year during multiple back surgeries. It's hellish, and it's made worse because they treat you like an addict. I'm still bitter as hell. I'm very sorry for what you're going through but count yourself lucky you do eventually have a way out with your other treatments.
FWIW, All of the people I knew with serious long term pain problems (cancer, Hep) became involved with street dealers for their meds and some were almost a collective; trading pills and patches as the scripts came due at different times. I can't say that's what you should do, but having been there I would understand.
No, it isn't. And this grows increasingly irrelevant to the OP's request, so take it to PMs or another thread if you really must persist. It is an SNRI, and can have bad interactions with SSRIs and so taking tramadol and an SSRI is to be avoided, but it is most definitely not considered an SSRI itself.