Oh the joys of receiving opiate drug treatment! I’m sure
at some point, it used to be a simple straightforward process to have your pain
treated. But thanks to the few, the rest of the world has to
be treated like suspects. From a patient’s perspective, it’s natural to feel
like you are the one being penalized and treated like a drug-seeker. But,
actually, it’s not just the patients. Because of the nut-job doctors out there who
handed out pain pills like Halloween candy to anyone who walked in the door,
now medical professionals are kept under a tight leash too. In most states, this
makes seeking pain management a pain in the butt … and the neck…the back, legs,
feet and many other areas.
Nearly every symptomatic TC patient I have spoken to has
a pain management doctor. It’s pretty much a general assumption that you do or
will have one because of the length of time you will be expected to be on
narcotic pain medications. One of the first things Dr. F’s office asks you for
is your PCP and Pain Management Doctor contact info so they can coordinate your
care. So, for you cysters out there, if you don’t have one and haven’t seen Dr.
F. yet, make plans to get one.
In my search for a pain management doctor (PMD), I learned
that not all PMDs are created equal. The TC Foundation advised me that the
preferred doctor to see for medication management is a Physiatrist. Unfortunately,
these are hard to find in my area. A Physiatrist is focused on pain management
and rehabilitating patients and take a holistic approach. This link explains
the difference between pain managements differences of physiatrist and an
anesthesiologist. https://treatingpain.com/pain-management-specialty
This video explains what a physiatrist does:
Most PMDs are anesthesiologists and their first line of
treatment is using epidural steroid injections (ESIs) to treat pain. For some,
if that doesn’t work for you, they will not want to be bothered by prescribing
you opiate medications. Ask this
question up front before you sign any medication management contracts. Of
course, like all, there are good ones and bad ones out there. Some are out to
make a good buck. They make the most money by performing those injections, not
by seeing you for an office visit to write a script. AND, they do those ALL DAY
EVERYDAY. At some clinics, if the ESIs don’t work it’s “Bye bye! Why would I
want to waste my time prescribing you pills, causing me more hassles to have to
deal with, when I’ve got 50 patients lined up for injections and I can make
$2000 a pop with them?”
From my information experience, the majority of TC patients do not benefit from Epidural
Steroid Injections, although some have had relief from them. For example, when
I had my Caudal ESI, the doctor told me he could not guarantee that the
medication would be able to reach between the cysts and the compressed nerves.
Guess he was right because the injection did jack squat. Caudal Epidural Injections for the Treatment of Tarlov Cysts:Suggestions for the Better Results addresses
the need for a different treatment approach for ESIs in TC patients.
 |
| As you can see here, I was very excited to have my Caudal Epidural Steroid Injection. However, the disturbing picture of my face after I learned the injection did not work has intentionally been omitted for viewer safety. (I'm kidding. I didn't really take a picture of my sad face.) |
If you get a doctor who doesn’t know what they are doing,
and they hit the nerve cyst with the needle, big time bad news. In my case, the
anesthesiologist was aware of the TCs and the injection site was far from the
cysts. I asked Dr. Feigenbaum if it was safe for me to have this procedure and he supported it. For more information on the
dangers of ESIs and TCs read the following: Anatomical causes of failed spinal anesthesia may becommoner than thought; The level of termination of the dural sac by MRI and its clinical relevance in caudal epidural block in adults and Minimally Invasive Interventional Therapy for Tarlov Cysts Causing Symptoms of Interstitial Cystitis.
So, during the referral process, it’s important to make
sure you are going to see a PMD that actually will prescribe you medication should you need them and
not just try to stick a bunch of needles in your back. Yet, conventional treatments should definitely take precedence over narcotic pain pills if they work. Also, to avoid having to
deal with the red tape, some of them will only prescribe them to you
short-term. As a TC patient, it is highly likely that you WILL need medication
management. Some require that you are treated with injections before they will prescribe
you medication. Ask this question before
you sign any contracts. My personal approach to pain pre-surgery . . . tough it out as long as I can and take a pain pill as a last resort. I do everything possible that I can to relieve my pain before taking one of those things. I AM scared to death of dependency. But, the unfortunate reality is, I need them sometimes.
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