Pain Management Clinics

allanmn · Post by **allanmn** » Tue Feb 03, 2009 9:21 pm

I would like to know if anyone goes to a pain clinic or know anything about them. My doctor prescribes two 7.5/500 mgs. of Lortab a day for my RLS pain. He is going to reffer me to a pain clinic. I have been trying to get him to increase the Lortab but he will not. Does anyone think I will have more success in the pain clinic ajusting my pain medication higher? The Lortab works great but I sometimes need an extra one on most days.

tashton · Post by **tashton** » Tue Feb 03, 2009 10:08 pm

I switched to a pain clinic after my doctor tried all the usual medications that are prescribed for RLS and no relief. I believe my doctor was glad to see me go. I have been on hydrocodone 7.5/325 now for about three years. Pain clinics are not afraid of prescibing narcotics for long-term use. My only suggestion for you is to stress to your doctor that you see at the pain clinic that you have pain associated with the RLS. When I first went to the pain clinic I basically told the doctor what helped me and the dosage that worked for me. After a long visit (the first appointment lasted over two hours) the doctor saw the issues through my eyes and gave me what I wanted. I believe the first visit was so long because he was making sure I wasn't just out looking for drugs. I have been able to remain at the original dosage and except for some occasional flare ups my rls is under control. My only complaint is that my medical insurance, which has good coverage most of the time, doesn't cover this pain clinic. So I pay for health insurance and still have to pay for the visits to this clinic.

Neco · Post by **Neco** » Wed Feb 04, 2009 2:51 am

Pain clinics can be expensive, that is true.. It sounds like your doc is just a stickler.. Many of us get stuff as strong as Methadone from our normal practitioners and don't have to jump through many special hoops, although we have demonstrated through trial and error that non-opiates (Requip, Mirapex, Neurontin/Lyrica) and lesser strength opiates do not generall work well for us.

Have you heard of or ever tried to show the Mayo Clinic Algorithm to your doctor? It is a guideline for RLS diagnosis and treatment of RLS from the Mayo Clinic.. They recommend all kinds of opiates; Tramadol, Codeine, Hydrocodone, Oxycodone, Methadone, and a couple others..

Many docs are igorant of RLS and even more scared of the FDA when prescribing pain meds, so it makes it very difficult for us..

If you go to the pain clinic, be sure and take the Mayo Algorithm with you. You can download it or view it from the following link, but you need Adober Acrobat Reader as its PDF.. But then you can print it out and take with you to doctors.

http://www.mayoclinicproceedings.com/co ... l.pdf+html

Post by **ViewsAskew** » Wed Feb 04, 2009 3:26 am

Not sure how many of us are successful getting strong opiates from our regular docs.

I asked my PC - we'd been together for years and she knew the hell I went through. She wouldn't. Not even by talking to my current doc or Dr B or reading books or the algorithm or whatever. I did it all.

I contacted 15 doctors over a two year period...not one of them would take me as a patient. In the meantime, I drove about 60 miles one way every month to the only doc I'd found that would help.

I finally found my current PC and am convinced that the ONLY reason she listened to me and agreed is that her grandmother was augmenting and she didn't have access to the right info until I showed it to her.

Pain clinics may be the best route for many of us.

SquirmingSusan · Post by **SquirmingSusan** » Wed Feb 04, 2009 8:17 am

Hi Allan. I've been going to a pain clinic since augmenting on Requip, and developing killer leg pain. My sleep doc basically dumped me because now my RLS/pain was all day long, and RLS is only supposed to be in the evening. So he wouldn't prescribe the Norco for daytime use.

The pain clinic has been great. They made me see the psychologist at first, but it was a breeze, and he basically told me that by the time patients got into the pain clinic that they had been through hell, and all kinds of mistreatment by the medical profession. The only thing that really bugs me is having to pee in a jar for them. But that's how they keep their noses clean with the DEA.

One thing is that they can't prescribe narcotics at the first visit, so expect to wait a month before getting your meds Also it can take a long time to get into a pain clinic.

Best wishes with it.

emmettdigger · Post by **emmettdigger** » Sun Feb 08, 2009 2:15 am

I would be curious to exactly why your doc was referring you to a pain clinic for management of RLS. I understand that the medication you're taking is to treat pain, but that's not why you're taking in, right? I don't have pain with my RLS so maybe you're taking the Lortab for RLS pain. If that's the case, disregard this comment

I do direct patient care in a hospital system and have experience with pain clinics in a professional capacity. I wonder if you're being referred on because your doc is concerned you have a dependency issue and that your requests for increasing doses of the Lortab is drug seeking behavior rather than a request for an adequate dose of the medication that staves off your RLS. I've seen more docs label patients in such a way because they see any request for narcotics as an indication of addictive behavior. Anyway - many pain management clinics will put you on a narcotics agreement and you have to follow it to the letter. That means if you take more of your Lortab to manage your symptoms as they intensify and run out before the end of a 30 day period, you'll be in violation of your agreement. I don't know if the doc who referred you is a sleep doc but if it's not, I might suggest trying to find a good sleep doc who will prescribe and manage narcotics scripts without suspicion.

Good luck!

mackjergens · Post by **mackjergens** » Sun Feb 08, 2009 5:43 am

I am one of he lucky ones, I take hydrocodone and ultram for my rls, I have NO pain just the creepy crawlies where I walk the floor all night, in years past I discovered thru dental work that the pain meds stop my rls, so for the last 8 or so years I have taken pain meds to control my rls.

I started out being given 90 hydrocodone pill each month, then I decided I wanted to try ultram and was allowed to have a prescription for both, but I reduce the amount of hydocodone pills from 90 to 30 each month.

I have never tried the Parkinson meds and hope I never have to. I am just very careful with my pain meds, and do not give my Drs any reason to stop providing them to me.

I do think many Drs will refer you to a pain Dr, because they are afraid of prescribing pain meds. Just my opinion!!

SquirmingSusan · Post by **SquirmingSusan** » Sun Feb 08, 2009 6:21 am

I had an interesting discussion with my doctor the other day about the hazards to doctors of prescribing narcotics. She was saying that she won't prescribe more than 90 methadone tablets a month to a patient, because of the paperwork involved in prescribing more than that. She said that if, for some reason, she prescribes more than 90, and they don't get the paperwork all completed to the letter, pretty soon the government stops by to harass the doctors. So beyond that amount of meds, she sends them to a pain clinic. Which is all fine and good, because in the St. Paul metro area there are several pain clinics.

She's the one who, a couple years ago, when I had the killer augmentation that started my chronic leg pain, totally ignored my pain and didn't prescribe anything. Fortunately, at this last visit, she was much, much more knowledgeable about the treatment of RLS and the fact that it can cause pain. And now I know that she DOES in fact prescribe methadone, and hopefully can get her to take over my meager methadone prescription from the pain clinic sometime soon.

I think most doctors who refuse to prescribe pain meds are covering their own rear ends, rather than worrying about us and the remote possibility of addiction - no matter what they say about it to us.

I am encouraged, though, that attitudes toward pain management do seem to be changing.

BTW, for me, my RLS changes back and forth between the creepy-crawlies and deep, tugging, aching pain. It's just 2 sides of the same coin. And I'm seeing more acknowledgement from doctors that RLS can indeed be painful.

Post by **ViewsAskew** » Sun Feb 08, 2009 8:37 am

emmettdigger wrote:I would be curious to exactly why your doc was referring you to a pain clinic for management of RLS. I understand that the medication you're taking is to treat pain, but that's not why you're taking in, right?

Emmett, you are so right! Some docs aren't willing to deal with the potential dependency and/or abuse issues, so they just won't prescribe them. As soon as you say, Um, this isn't working, I need more, you are suspect. In some cases, you are suspect before you EVER take it! Even though the Mayo Clinic Algorithm says that opioids should NOT be withheld if other treatments do not work, they won't go there in the first place. Also, in some states, methadone can ONLY be prescribed by a pain clinic OR and methadone maintenance facility for the heroin withdrawal.

Some people with RLS do have pain so the narcotics offer a 2 for 1 deal. But, mostly narcotics are just pretty darn good at removing the offending sensation and urge to move part of RLS.

Arnie · Post by **Arnie** » Wed Feb 11, 2009 7:05 am

Is it possible that the RLS and the pain in the legs are two separate conditions?

Arnie · Post by **Arnie** » Wed Feb 11, 2009 7:16 am

Ya know, I have had RLS all since i was in my twenties! I t was never really bad! Got it 3 or 4 times aweek late in the evening when i get on the recliner and relaxed before bed! I learned through experiments that calcium/magnesium and later i added on Taurine, would stop RLS within a half hour! Now at 61, i have it real bad at night ! I think what happen was about 3 years ago i started getting head achs real bad! A Neurologist prescribed Neuronton and later Lyrica! After one year i stoped the meds and thats when my RLS took off! Spinning out of control at night! So now I'm back on the Lyrica which stops it! but i also think thats what triggered it! So not I'm stuck! Arnie

Arnie · Post by **Arnie** » Wed Feb 11, 2009 7:20 am

I tried to upload my photo. but it wont work! i never had this problem before! Anybody have any suggestions! I'v had no problems on other sites! Arnie

Post by **ViewsAskew** » Wed Feb 11, 2009 8:19 am

Hi Arnie,

You can't use the upload in your membership file or whatever it's called. Look at these instructions instead. You have to host the picture on another internet site somewhere...

http://bb.rls.org/viewtopic.php?t=5493&start=0

Post by **ViewsAskew** » Wed Feb 11, 2009 8:23 am

Oh, just had a thought, Arnie....RLS often worsens as we age. Since Lyrica and Neurontin both help treat RLS, I wonder if they simply kept your symptoms under control, so you felt at if you didn't have it. When you stopped it, then you could feel it again.

I'm not saying for sure that one of them didn't trigger it, simply that it's not something we've ever heard of. Since they Lyrica does work, my guess is that it simply prevented you from knowing it was getting worse over time.

SquirmingSusan · Post by **SquirmingSusan** » Wed Feb 11, 2009 8:32 am

Arnie wrote:Is it possible that the RLS and the pain in the legs are two separate conditions?

Yes, of course it's possible. Often RLS is accompanied by neuropathic pain, which is a separate condition caused by nerve damage from diabetes or back surgery or other trauma.

I know that for my own RLS, though, that the pain and the creepy-crawlies are interchangeable. There have been times when I've had pain, and I've taken weaker drugs that I normally take, that the pain morphs into the other sensations as the medicine kicks in. And lately, my RLS hasn't been as intense, and it's less pain, more creepy-crawlies. It's almost as if my body reaches a threshold with the sensations where my brain just interprets it as pain. And movement helps both the pain and the creepy-crawlies for me as well.