Re: First stop ...

On Mon, 6 Mar 2006 20:54:47 -0500, "Andy Sandale"
<andy.sandale@xxxxxxxxxxx> wrote:

A couple of weeks ago I located this group and posted something asking about how to
begin seeking relief from neuropathic pain in my feet (from diabetes) that has become
so severe that walking is very difficult for me ... and it is endangering my job.

I've since managed to get my insurance company to provide me the name of an
anesthesiologist-pain specialist in my area, and I have an appointment on Wednesday
morning.

Today I received some paperwork in the mail from the doctor ... regular stuff, like a
form granting permission to them to get my medical records from my internist, and stuff
like that. No problem.

But the doctor's letterhead was all about "Innovation in Pain Management and Spinal
Diagnoses." The doctor isn't an orthopod, but an anesthesiologist. Now I have this
sinking sense that, since I have no spinal problems, the visit will be a waste of time.

It took me a couple of years ... during which time the pain in my feet has gone from
bad to barely endurable ... to even make the decision to seek treatment of the pain. I
am prepared to be subjected to batteries of useless and painful tests (I remember what
my ex-wife had to endure when she once had a pinched nerve ... electromylograms, nerve
conduction tests ... torture, basically) and fully expect to be fobbed off with useless
and ineffective medications for years before even daring to hope that I will find a
doctor who will actually treat the pain. And this is why I didn't start this process
earlier ... but now, my ability to function is so impaired that I have no options left.
My internist is a good man, and he has tried me on Neurontin and tricyclics and
carbamazepine, and even gives me Percocet 10/325, sixty whenever I ask, with directions
to take one or two as needed every eight hours. The Percocet is the only thing that
has even made a tiny dent in the pain, and I really mean just a tiny dent. Realizing
that neuropathy doesn't get better ... in fact, it gets worse ... I honestly felt that
my internist was doing all he could reasonably be expected to do, and I was going to
have to begin the endurance test that apparently is necessary to filter drug abusers
out of the system so pain specialists can work with a reasonable chance of hanging onto
their medical licenses and staying out of jail.

But now I'm really afraid that I'm going to be told that this doctor only treats spinal
problems. Two other factors against me: first, my appointment is at 8:00 am, and, in
the morning, I can generally walk fine and often even have the delusion that I'll get
through the workday okay. He'll be seeing me right after I've gotten up, which is the
closest to pain-free that I ever am. And I don't want to do any "acting" or any other
kind of deception.

Worse ... I have a graduate education in pharmacology (I once taught the subject at a
medical school, in fact). Doctors hate informed patients; how much more will they read
the level of understanding of pharmacology that *I* have as marking me as a
drug-seeker (of course I'm "seeking drugs" ... why else would I be going to a doctor?
Although, of course, if he could make this pain disappear with a magic wand, I would
kiss his feet for that, too).

The treatment of extremely painful neuropathy is a matter of "controversy" among
doctors ... that there is "controversy" is beyond dispute, but the entrenched idea that
neuropathic pain is unresponsive to opioids is simply false, as a scientific matter.
Neuropathy requires slow titration to unusually high doses ... but every study that has
seriously looked at the matter has found that it *is* responsive to conventional
analgesics. However, such doses (rightly, given that their livelihood is on the line)
strike fear into the hearts of even the most caring physicians, and they will do
everything they can to "treat" the pain with various antidepressant or anticonvulsant
drugs. While these drugs are no doubt useful adjunctively, they simply won't suffice
as monotherapy for pain of this magnitude. And what I endure every day gives new
meaning to the concept of "walk a mile in his shoes."

I'm not even sure what I'm trying to say here. Mostly, I'm just afraid that I'll be
turned away at the door because my pain is not "spinal" in origin. What then? Back to
square one? What is the average amount of time people spend jumping through the hoops
before any serious effort is made at pain control?


Andy


Could you post any references to studies showing Opiates have a
positive impact on neuropathic pain? It sort of flies in both
everything I've currently read on the subject an all that I've been
told by untold Doc's.

TIA
--

December 9, 2005 (CNN) While interviewing an anonymous
US Special Forces soldier, a Reuters News agent asked
the soldier what he felt when sniping members of Al Quaeda
in Afghanistan.

The soldier shrugged and replied, "Recoil." (Possible Urban Legend)
.

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