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I see my pain psychiatrist tomorrow.
5 Replies
Noca - April 7

I see a new doctor tomorrow, a pain psychiatrist. I don't know what I'm supposed to be doing as a chronic pain patient.

Fentanyl 25mcg/h seems to do absolutely nothing positive nor negative(unless I forget a patch). My max dose of PRN Dilaudid (16mg) is the only thing that seems to take the edge off my pain.

My Nortriptyline at 50mgs does absolutely nothing, might as well be a sugar pill. I really don't know what I'm supposed to do.

Maybe max out at 150mg of Nortriptyline and try higher doses of Lyrica(past dose was 150mg a day)?

The thought of being in pain for the rest of my life is really depressing, I'm only 23... I read these people who say they overcame their pain and live without meds, I just don't see how that is possible.


Fantod - April 7

Noca - I "borrowed" this information from another site:

You may be referred to a psychiatrist, psychologist or social worker to help you cope with chronic pain. Before you run the other way, read on…

Does this mean my doctor thinks the pain is “in my head,” or I’m crazy? No. Chronic pain is real. Often, it is also very hard to treat, so having a team work with you to treat the pain from different angles can help. A mental health person can often help you decrease your pain levels, as well as cope better with the pain you have.

How can a psychiatrist help me? There are several ways a psychiatrist can help. These include:
1. Support and problem-solving, as you face this great challenge. Just having someone to talk to about how you’re doing and what problems you’re facing is helpful. I also help patients figure out how to deal with problems that come up because of pain. Pain can affect all areas of your life, including work and relationships. Talking about these other areas and solving problems that come up in them is helpful.

2. Teaching skills that can decrease your pain, such as relaxation, visualization and guided imagery exercises. Hypnosis is sometimes a helpful addition.

3. Helping you figure out what activity is helpful, and what activity hurts in your present condition. “Pacing,” which is monitoring your activity level, to do as much as possible while keeping your pain under control, is a helpful skill. You may learn to replace activities you can no longer do with other ones you enjoy. Or you might learn to modify activities so you can still do them. For example, someone who used to like to garden for hours at a time may no longer be able to do that because of pain. But she may be able to garden over several shorter time periods (pacing), or garden in raised containers instead of her garden (modifying), or take up knitting instead (replacing).

4. Figuring out with you which of your usual coping skills are helpful to you and which ones may be getting in your way. For example, some people respond to difficulty by working harder. This may be helpful if you work hard to find information on your condition, but it could get in the way if you apply this to physical therapy exercises, doing 100 when you were instructed to do 10. In contrast, some people immediately give up and think the worst will happen to them. A psychiatrist would help you examine which of your thoughts interfere with functioning, and help you replace them with more realistic thoughts.

5. Medication. A psychiatrist is a doctor who can prescribe medication to help decrease pain or increase your ability to handle your situation. These medications can be helpful even if you don’t have depression or anxiety. These medications include antidepressants, anti-anxiety medications, anticonvulsants, and others. Some psychiatrists prescribe narcotics.

6. Evaluate if you have depression or anxiety that is contributing to your pain. A psychiatrist can diagnose and treat conditions like depression or anxiety that often come along with pain disorders. Treatment may include both therapy and medications.

7. Help you sleep better. Many patients with pain have a difficult time falling asleep or staying asleep. Psychiatrists can treat this problem by teaching you skills to help with sleep or by prescribing non-addicting medication if needed.

You probably know all this anyway since you are a very smart person. I think that this doctor may be more helpful to you than the rest of them put together. I hope that you will be open to the possibility.

By the way, I wanted to comment on your recent posts. You seem pretty engaged with the group as a whole. It is really nice to see your participation both asking and answering questions. You've come a long way and I, for one, am glad you are a part of this group. Good luck tomorrow.


Noca - April 7

Thanks for the advice and the compliment Fantod. I help as much as I can. I plan on being a psychologist one day and helping people for a living.


Fantod - April 7

Hi Noca - Just wondering how your appointment went today.


Noca - April 8

My appointment was an absolute fail. The doctor looked like she was in her late 80's, she started right off by saying she doesn't like using medication.

She asked about my med history which is probably the 20th time I've had to repeat it by now. She asked about what my goals were in seeing her and I said to change my medication and learn new coping methods for pain. She asked me what my problems were and I started off by listing my illnesses and as soon as I said "fibromyalgia" she was just like "do you know what that is?" and I said "yes, its a pain syndrome of wide spread bodily pain with lots of comorbid illnesses. And she was like "it means pain of the muscles, and as soon as I said "comorbid" she played dumb and asked me what that is. I answered her and we continued.

She asked me what else I had problems with, and I said "depression" and she was like "what do you mean depression?" and I started listing off the symptoms starting with "low mood" and shes like "what do you mean by low mood?".

It got really annoying real quick. She kept belittling me and treating me like an idiot. I've already been diagnosed a million times and I didn't need to list off all my symptoms just to prove I had each illness or I would be with her all year.

At one point I said my pain has been so bad that I've gone to the ER begging for help and of course shes like "what did you expect them to do?" and I said "give me a shot of IV Dilaudid". The next thing she said REALLY pissed me off! She said "Oh well I guess you just don't want to experience ANY pain at all then do you?" as if I'm some wimp when I just said I was in agony at that point in the ER, as if I went there for a foot ache or something geez.

Overall she was a bitch and a complete waste of my time. She treated me like an ignorant child and acted like an annoying one herself asking "why?, *answer*, why? *answer*, why? *answer* and so on every time I used a medical/psychological term.

She wanted me to fill out some 350 question questionnaire and come back to see her May 7th. I'm sorry but I don't need to waste my time getting re-diagnosed with the all mental illness's I've already been diagnosed with previously and that I know I have, especially if she refuses to use any medication.


Fantod - April 8

Hi Noca - I'm sorry that the appointment didn't work out at all for you. Honestly, there are some doctor's that should just hang it up and go home (and stay there). Should you report her to someone?

I have a long lists of medication, allergies and medical problems too. Although they are nothing like yours, I keep a running, comphrensive list on my computer. Every time I go to the doctor whether they are new to me or not, everyone gets "the" list which is now comprised of 3 pages. It has my name, date of birth and the current date on each page. That way, I don't have to sit there and recite from a usually faulty memory what the h*ll is wrong with me and why am I there. My doctor's are now trained so if I happen to show up without it, they usually ask if I have a new copy available. Just a suggestion - I HATE repeating myself too.

I hope that you have a decent day today. Try not to dwell on that highly educated idiot. No point in wasting good energy when it is needed elsewhere. Take care.



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