What is pain management?

Posted by martoof @martoof, Oct 18, 2021

Is pain management (PM) merely *not complaining*? Making pain subside or go away? Distracting oneself from the pain? I ask because I recently went to a pain management clinic, where after a lengthy intake/question process, I was prescribed Vicodin! Any qualified, serious input would be deeply appreciated! Thank you!

Interested in more discussions like this? Go to the Chronic Pain group.

@sueinmn

I am sorry @martoof, to hear of this awful experience. That is not Pain Management. I would love to have people refer to the process (subspecialty) as "Active Pain Management" because it is not a passive process of adding another pill…

Pain management as practiced by my Pain Management specialist consists of the following:
– Review patient medical records for history and present and past symptoms and treatments
– Interview patient (in my case remote, due to Covid) to determine current state, hopes, expectations and willingness to fully participate
– Coordinate with primary care practitioner
– Explain the concepts of actual physical pain response, Central Sensitization Syndrome (CSS), Chronic Regional Pain Syndrome (CRPS), Neuropathy and philosophy of using a multi-pronged strategy to deal with whichever is causing the most problem. In my case, I have CSS and physical pain from arthritis.
– Explain that opioids do not really cure pain, and that the goal, if currently used, is to end or minimize their use. My body had never become dependent on narcotics for pain management, so I didn't have to break that cycle.
– Explain that the goal is to minimize and manage pain, as the underlying causes usually don't "go away"
– Develop a comprehensive pain management strategy. In my case it was a combination of physical therapy (PT) and myofascial release (MFR) by a specially trained therapist, a home routine of stretching, strengthening and walking, medication (non-narcotic), visualization exercises, and becoming attuned to what my body is saying to me.
– Review progress and adjust to find balance.

Since I started active pain management almost a year and a half ago, I have gotten my life back. It is not perfect – there are bad days and good days, I have learned to take them as they come, and which tactic to use for specific issues. I have learned that all of the strategies must stay in place for life – if you stop, the pain can come roaring back. I have hard surgery 3 times since I began active pain management, and managed recovery from each one with minimal opioids (2 days max) by using Tylenol, ice and my PM strategies. I use topical NSAIDS only for arthritis pain because I cannot use the meds internally, combined with ice or heat as needed.

Sorry, I cannot refer you to my pain management specialist, she operates on referral only, and from within the clinical practice where my primary is located. Mayo offers an inpatient Pain Rehab Clinic (https://www.mayoclinic.org/departments-centers/pain-rehabilitation-center/sections/overview/ovc-20481691) There are other qualified Pain Management specialists and practices all over the country. Based on your experience, I would call and pre-interview any place to which I was referred to learn their philosophy.

I encourage anyone with a Pain Management experience to tell us about it.
Sue

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Wow, thank you Sue! I have just been referred to pain management by a nurse practitioner who I thought would be a neurologist to explain what my MRI’s showed. I won’t go into that now. All she offered was PM, I will definitely research the clinic which I was referred to. I will not take narcotics for any pain, there are too many horror stories out there I will Search for a natural remedy to manage my pain. Thank you again Sue.

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@phreds

Wow, thank you Sue! I have just been referred to pain management by a nurse practitioner who I thought would be a neurologist to explain what my MRI’s showed. I won’t go into that now. All she offered was PM, I will definitely research the clinic which I was referred to. I will not take narcotics for any pain, there are too many horror stories out there I will Search for a natural remedy to manage my pain. Thank you again Sue.

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This is the time when you need to become your own best advocate for your health care.
"Pain Management" means different things to different people, but what we are discussing (maybe even promoting) here is a multi-pronged approach, that includes many elements such as physical therapy, exercise, meditation, visualization, massage, acupuncture, and in some cases, medication.
It requires commitment to trying many avenues until you find what works for you.
If you want an example of a comprehensive pain program, you can read about Mayo's here: https://www.mayoclinic.org/departments-centers/pain-rehabilitation-center/sections/overview/ovc-20481691
I was helped at the local pain management clinic that is part of my clinic' network.
Sue

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Sue, what I’ve “think” I’ve discovered, is that pain management doctors still want to cut some part of your body where the pain is. The one that dismissed me, wanted to do a spinal stimulator. I’ve already had three major back surgeries, and am not going to have anything else implanted in my back. I had all the hardware taken out of my back on my third surgery, because it just made it so much worse. My knee pain from an arthroscopic meniscus tear surgery, has never gotten better. I stopped going to therapy because the laser they put on my knee felt like my leg was being electrocuted! As far as opiates go, there’s such a STIGMA attached, and it really makes me angry. I take everything as prescribed; if it takes the edge off so you can at least function, what is the harm? I’m 70. Not someone young who might be running around the streets looking for drugs. I’d rather have the remaining years of my life as pain-free as possible. Opioids have never affected me in the way most people react to them. I don’t get a “high feeling” at all. Of course, that’s the first thing you’re accused of… drug searching. If I’m accused of that, all I can say is “Yes. I’m doing this the legal way. I’m in constant pain, and you’re the only one who has the power to write a prescription.
I’ve had too many surgeries, cut from front to back, hip replacement, and reconstruction of my right foot. I don’t want any more doctors cutting into me.

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@sandysurf

Sue, what I’ve “think” I’ve discovered, is that pain management doctors still want to cut some part of your body where the pain is. The one that dismissed me, wanted to do a spinal stimulator. I’ve already had three major back surgeries, and am not going to have anything else implanted in my back. I had all the hardware taken out of my back on my third surgery, because it just made it so much worse. My knee pain from an arthroscopic meniscus tear surgery, has never gotten better. I stopped going to therapy because the laser they put on my knee felt like my leg was being electrocuted! As far as opiates go, there’s such a STIGMA attached, and it really makes me angry. I take everything as prescribed; if it takes the edge off so you can at least function, what is the harm? I’m 70. Not someone young who might be running around the streets looking for drugs. I’d rather have the remaining years of my life as pain-free as possible. Opioids have never affected me in the way most people react to them. I don’t get a “high feeling” at all. Of course, that’s the first thing you’re accused of… drug searching. If I’m accused of that, all I can say is “Yes. I’m doing this the legal way. I’m in constant pain, and you’re the only one who has the power to write a prescription.
I’ve had too many surgeries, cut from front to back, hip replacement, and reconstruction of my right foot. I don’t want any more doctors cutting into me.

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I am sorry that has been your experience. Have you consulted a comprehensive pain management clinic, such as Mayo and some other places offer? you can read about that here: https://www.mayoclinic.org/departments-centers/pain-rehabilitation-center/sections/overview/ovc-20481691

My sister told me the same about a "pain specialist"- all he offered was injections – in our large clinical network. But when she asked for more services, was referred for comprehensive evaluation, physical therapy, focused meditation and medication management…similar to my experience.

One thing most pain management programs do stress is that opioids are not effective for long term management of chronic pain, so if you are adamantly opposed to cutting down or giving them up, you will be unhappy with the process.

However, the approach includes training in many tools to deal with the pain and its management – you are not just cut off and left hanging.
Sue

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@sueinmn

I am sorry that has been your experience. Have you consulted a comprehensive pain management clinic, such as Mayo and some other places offer? you can read about that here: https://www.mayoclinic.org/departments-centers/pain-rehabilitation-center/sections/overview/ovc-20481691

My sister told me the same about a "pain specialist"- all he offered was injections – in our large clinical network. But when she asked for more services, was referred for comprehensive evaluation, physical therapy, focused meditation and medication management…similar to my experience.

One thing most pain management programs do stress is that opioids are not effective for long term management of chronic pain, so if you are adamantly opposed to cutting down or giving them up, you will be unhappy with the process.

However, the approach includes training in many tools to deal with the pain and its management – you are not just cut off and left hanging.
Sue

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Sue, I find it very hard to “deal” with pain.

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@sandysurf

Sue, I find it very hard to “deal” with pain.

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Hi @sandysurf. Perhaps you've never been properly taught how to deal with pain. I too once thought my legal opiod prescription took the edge off (literally my words also) and I could not imagine any other way to cope and live with pain.

I graduated Mayo Pain Rehab last year and my classmates ranged from 18 to 74. Age is not a factor. I understand your angle because my 71 year old mother thinks she's too old and says it's just the way it is. I'm here to tell you…that's not true for everyone. Mayo PRC works a safe supportive plan to ease people off opiates and provides training and guidance to help them succeed going forward.

I can talk until I'm blue in the face to help someone want to learn a better, more healthy positive path forward, but it has to come from inside. A person must want change.

I'm here for you @sandysurf. Do you have any specific questions about my pain rehab experience?

PS: I love your handle…sandy surf makes me happy too. 🏝

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@sandysurf

Sue, I find it very hard to “deal” with pain.

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I'm not sure of the terminology to use, but dealing with pain doesn't just mean "putting up with it" or "toughing it out". Chronic pain is a nervous system overreaction, and you learn strategies to overcome it .
It doesn't mean you will be pain free – after 70 years of living, most of them very active, and with arthritis just about everywhere except my jaw and my ankles, numerous surgeries, as well as other ailments, I realize there will be pain. My goal is to take every possible action to minimize it, including diet, stretching and exercise, rest, PT, massage, meditation…
Within reason, the more I move, the better I do, but a full day of strenuous work is now beyond me and I have learned to (usually) listen when my body says "rest."

When I started this journey, I was amazed at what could be accomplished without NSAIDS or opioids – not everything we tried was helpful, but I found enough tools for a satisfying life.

I encourage you to consider giving it a try.
Sue

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For me, pain mgmt is all of the above. Opioids as needed, PT, mental health, epidurals, preventative maintenance, and keeping a journal of what I did each day. So if my pain suddenly gets worse I can look back at what I have been doing or not been doing. Etc.
I am lucky that I did find a great Doctor who does not just feed you pills and check your urine. Been there done that and while it helps it's like putting a bandaid on a gunshot wound.
Best wishes to all of you who do the daily grind with me. While I will never be healed physically my mind is in a great place !

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@budo7

For me, pain mgmt is all of the above. Opioids as needed, PT, mental health, epidurals, preventative maintenance, and keeping a journal of what I did each day. So if my pain suddenly gets worse I can look back at what I have been doing or not been doing. Etc.
I am lucky that I did find a great Doctor who does not just feed you pills and check your urine. Been there done that and while it helps it's like putting a bandaid on a gunshot wound.
Best wishes to all of you who do the daily grind with me. While I will never be healed physically my mind is in a great place !

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@budo7 Hello and welcome.Thank you for your uplifting post, and contributing to the pain management conversation, you've inspired me!

Finding a good doctor can be key. I'm glad you have one.

I like that you keep a journal, it's an excellent idea for accountability. I use a daily/weekly planner to schedule my days. It helps plan and structure things like morning stretches, cardio, physical therapy, meals, relaxation and socialization. I also look back and see when I push and crashed. I use a bright highlighter to mark those times, then plan better next time.

Do you have any other tools or coping mechanisms that you wish to share with the community?

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@budo7

For me, pain mgmt is all of the above. Opioids as needed, PT, mental health, epidurals, preventative maintenance, and keeping a journal of what I did each day. So if my pain suddenly gets worse I can look back at what I have been doing or not been doing. Etc.
I am lucky that I did find a great Doctor who does not just feed you pills and check your urine. Been there done that and while it helps it's like putting a bandaid on a gunshot wound.
Best wishes to all of you who do the daily grind with me. While I will never be healed physically my mind is in a great place !

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What a terrific post.
I think what needs to be added to your list is "positive attitude."
My neighbor would add "a plan for each day." She said she makes a list of 2 things every morning that must be done – like clean the litter box and buy groceries. If she finishes that, she feels her day went well. If she does more, great. She is a terrific artist, and says if she can't paint on a given day, she tries to watch a video or read an article about art, or plan her next project.
Sue

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I was just put into pain management. I have a diagnosed issue that is very unheard of, Pudendal Nerve Entrapment. This got worse when the nerve was injected 3 months ago with a steroid. Since then it has gotten progressively worse, now all over where the pudendal nerve is. This is completely debilitating & the only people who even get it are seasoned urogynecologists. Since being so unknown the pain management folk do not get this at all. I have never ever needed pain pills in my life until those nerve injections, and definitely need a pain management that understands this issue. So far it has taken me 3. Right now, I'm in horrendous pain, rectal, perinium, labia, buttocks, thighs, bladder, ect. This nerve pain flares, and is debilitating. I finally am seeing a very good urogynecologist at LomaLinda tomorrow!!! We will most likely do botox to the pelvic floor muscles involved. Until I get the issue resolved I need understanding kind compassionate
Pain management for this, as soon as pain from the nerve is lighter, decompressed, ablated, & exact location found ..I will still be in pain during urinating and defacating. This started from being over dilated in a simple hemorrhoid banding
5vyrs. Ago…the damage to my rectum took 10 colorectal surgeons to find. Not only nerve damage but 3rd degree rectal descent. My pain never needed pills, until after major surgery this year, robotic assisted ventral biological mesh rectopexy, cystocele and rectocele repair. I wasxtold my rectum could be fixed, but the pain after defamation would not.
I when healed was doing great, seeing a pelvic floor therapist who got too aggressive hitting the pudendal nerve. This then was treated with pudendal nerve block…now hopefully the urogynecologist will start to help the nerve. This is the urogynecologist who first found the issues from scar tissue in the internal spinchter complex. So during this disorder which many men & women have…there will be pain, and pain management for this is difficult…as they are there to remove the medication to help. Been very difficult…I needcall to communicate and they don't. I belong to a forum on Pudendal Nueralgia…so misunderstood ER doctors are just starting to get it, but can do nothing for it. Some how I need understanding pain management, I will discuss this with my doctor tomorrow as all who have this are in debilitating pain, and grasping for help. He knows, people come from very far. This is also called Cyclist Syndrome. Pain management needs to understand and communicate with the doctor..as soon as this gets under control…I want off all pain meds..as I have never been any kind of pain pill person, but they sure help right now. My plan is to get fixed, and taper off asap. Wishing all who have this luck…not any cake walk….sorry if too long…but maybe I helped or educated a few!!!
.

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@olivedog

I was just put into pain management. I have a diagnosed issue that is very unheard of, Pudendal Nerve Entrapment. This got worse when the nerve was injected 3 months ago with a steroid. Since then it has gotten progressively worse, now all over where the pudendal nerve is. This is completely debilitating & the only people who even get it are seasoned urogynecologists. Since being so unknown the pain management folk do not get this at all. I have never ever needed pain pills in my life until those nerve injections, and definitely need a pain management that understands this issue. So far it has taken me 3. Right now, I'm in horrendous pain, rectal, perinium, labia, buttocks, thighs, bladder, ect. This nerve pain flares, and is debilitating. I finally am seeing a very good urogynecologist at LomaLinda tomorrow!!! We will most likely do botox to the pelvic floor muscles involved. Until I get the issue resolved I need understanding kind compassionate
Pain management for this, as soon as pain from the nerve is lighter, decompressed, ablated, & exact location found ..I will still be in pain during urinating and defacating. This started from being over dilated in a simple hemorrhoid banding
5vyrs. Ago…the damage to my rectum took 10 colorectal surgeons to find. Not only nerve damage but 3rd degree rectal descent. My pain never needed pills, until after major surgery this year, robotic assisted ventral biological mesh rectopexy, cystocele and rectocele repair. I wasxtold my rectum could be fixed, but the pain after defamation would not.
I when healed was doing great, seeing a pelvic floor therapist who got too aggressive hitting the pudendal nerve. This then was treated with pudendal nerve block…now hopefully the urogynecologist will start to help the nerve. This is the urogynecologist who first found the issues from scar tissue in the internal spinchter complex. So during this disorder which many men & women have…there will be pain, and pain management for this is difficult…as they are there to remove the medication to help. Been very difficult…I needcall to communicate and they don't. I belong to a forum on Pudendal Nueralgia…so misunderstood ER doctors are just starting to get it, but can do nothing for it. Some how I need understanding pain management, I will discuss this with my doctor tomorrow as all who have this are in debilitating pain, and grasping for help. He knows, people come from very far. This is also called Cyclist Syndrome. Pain management needs to understand and communicate with the doctor..as soon as this gets under control…I want off all pain meds..as I have never been any kind of pain pill person, but they sure help right now. My plan is to get fixed, and taper off asap. Wishing all who have this luck…not any cake walk….sorry if too long…but maybe I helped or educated a few!!!
.

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I also had enhanced pain after cryoablation of the pudendal nerve. It made my pudendal neuralgia worse. So no more pudendal injection. Like you can find no to help with dealing with the pain. Am looking at SCS but cannot find any body that has had this treatment for pudendal neuralgia.

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