Help in getting doctor to take pain seriously
February 9, 2018 8:00 AM Subscribe
I am struggling to get my primary care physician to take my ongoing (at times debilitating) pain seriously. Please help me frame my concerns to him in such a way that he won’t keep blowing me off.
I am a middle-aged woman in the U.S., enrolled in an HMO. I have a long history of generalized back pain, as well as a host of other medical issues, some of them quite serious. Last May, while walking my dogs, I bent over and felt a kind of pop in my neck. Within a few days I was in excruciating pain, with very limited movement, unable to sleep, and my daily activities severely curtailed (driving, working etc.). When I was finally able to see my primary care physician in June, he did an X-ray, said that I had mild arthritis in my neck and he prescribed working from home for a few weeks and physical therapy.
I asked if I should have an MRI to make sure I hadn’t herniated a disc and/or if I should see an orthopedist, pain specialist, etc. He said that wasn't necessary. In terms of pain management, he said that Tylenol (acetaminophen) or Advil (ibuprofen) was sufficient. I explained that I was getting virtually no relief from maximum doses of Tylenol (and given its risks of liver damage, I was unwilling to keep taking it at such high doses), and reminded him that I have a bleeding condition (which is well-documented in my medical records) that means I can only take minimum doses of ibuprofen (or any other NSAID) very sparingly. He prescribed an NSAID that "might not" be so risky in terms of my bleeding condition, along with a muscle relaxant. When I asked about prescription pain medication—even a short course—he looked at me sharply and said "that is inappropriate" and basically ended the appointment.
[Aside re: prescription pain medication: I know there is an opiate crisis in this country; it is a terrible, terrible, terrible thing that needs to be addressed socially, medically, etc. But A) severe pain is still a physical reality for many people, and B) I have been a perfectly responsible patient in terms of prescription pain medication in the past (I was prescribed painkillers after a series of surgeries several years ago, and was actually so cautious about taking them out of fear of developing a dependency that my surgeon actually told me I needed to take them more frequently so that I could stay in front of the pain).]
Finally in August—three months after the initial incident, during which I was making do with ice packs, small doses of ibuprofen, and OTC sleeping aids at night (the NSAID he prescribed gave me severe stomach pain, and the muscle relaxants were ineffective except at making me extremely drowsy/dizzy)—I was able to get in for 6 physical therapy sessions, which helped slightly. By the fall I had basically settled into daily moderate pain, punctuated here and there with episodes of severe pain. My daily activities and ability to sleep have never fully returned to the levels they were before last May, and at this point I feel chronically sleep-deprived. He literally (literally literally, not figuratively literally) shrugged when I told him this the last time I saw him several months ago and asked again whether I should see a specialist, get an MRI, etc.
[Aside re: other options for pain management: In the past 9 months I have also tried acupuncture (actually made things much, much worse), chiropractic (either does nothing or helps only slightly for a short period of time), myofascial release (helped a fair amount, but is not covered by my insurance and is very expensive, so I can’t afford to do it on an ongoing basis), and medical cannabis, in particular CBD oil (have tried different strains, edible vs. vaping, etc., and it has been very hit and miss; sometimes it helps a little, sometimes it does nothing, and other times it actually seems to amplify my pain awareness, but so far it has not really presented a solution).]
This past week, I felt the same pop in my neck, and have been in severe pain all over again. I recently started working with a personal trainer to try to build up some of the muscle tone I’ve lost over the past 9 months (being unable to exercise on my own without reinjuring myself), and she was very concerned and advised me to contact my doctor immediately. I emailed him and asked him again about a referral for an MRI and/or orthopedist. He said he would need to see me first, so now I’m waiting for an appointment to see him.
This has had—and I have said this to him in these exact words, more than once—a serious impact on my overall quality of life and productivity at work. I believe very strongly that my pain is being undertreated, possibly in part because of the opiate crisis and his concerns that I am drug-seeking, and possibly in part because I am a woman and he may be seeing me as being an unreliable narrator of my own experience.
QUESTION: what exactly should I do or say, at my next appointment, to maximize the chances of him taking me seriously? I feel like he's very good when it comes to assessing things that can be quantified by numbers (e.g., bloodwork to manage a completely unrelated chronic condition of mine, for which he's been the best doctor I’ve ever had), but is distinctly unable to empathize with issues that can’t be quantified in the same way (pain, anxiety, etc.). I have considered having my husband attend the appointment with me and/or bringing in a note from my boss to affirm that the pain has indeed been serious, ongoing, and disruptive (it sucks to feel like I need men to essentially act as witnesses to get another man to believe me, but here we are). I am willing to consider changing primary care physicians entirely if it comes to that, but that will take time (i.e., time to get it processed through the HMO, then time to get an appointment with a new doctor), and I am concerned that just the act of changing doctors could come across as doctor-shopping/drug-seeking, in which case I’d be in the same boat all over again.
I am a middle-aged woman in the U.S., enrolled in an HMO. I have a long history of generalized back pain, as well as a host of other medical issues, some of them quite serious. Last May, while walking my dogs, I bent over and felt a kind of pop in my neck. Within a few days I was in excruciating pain, with very limited movement, unable to sleep, and my daily activities severely curtailed (driving, working etc.). When I was finally able to see my primary care physician in June, he did an X-ray, said that I had mild arthritis in my neck and he prescribed working from home for a few weeks and physical therapy.
I asked if I should have an MRI to make sure I hadn’t herniated a disc and/or if I should see an orthopedist, pain specialist, etc. He said that wasn't necessary. In terms of pain management, he said that Tylenol (acetaminophen) or Advil (ibuprofen) was sufficient. I explained that I was getting virtually no relief from maximum doses of Tylenol (and given its risks of liver damage, I was unwilling to keep taking it at such high doses), and reminded him that I have a bleeding condition (which is well-documented in my medical records) that means I can only take minimum doses of ibuprofen (or any other NSAID) very sparingly. He prescribed an NSAID that "might not" be so risky in terms of my bleeding condition, along with a muscle relaxant. When I asked about prescription pain medication—even a short course—he looked at me sharply and said "that is inappropriate" and basically ended the appointment.
[Aside re: prescription pain medication: I know there is an opiate crisis in this country; it is a terrible, terrible, terrible thing that needs to be addressed socially, medically, etc. But A) severe pain is still a physical reality for many people, and B) I have been a perfectly responsible patient in terms of prescription pain medication in the past (I was prescribed painkillers after a series of surgeries several years ago, and was actually so cautious about taking them out of fear of developing a dependency that my surgeon actually told me I needed to take them more frequently so that I could stay in front of the pain).]
Finally in August—three months after the initial incident, during which I was making do with ice packs, small doses of ibuprofen, and OTC sleeping aids at night (the NSAID he prescribed gave me severe stomach pain, and the muscle relaxants were ineffective except at making me extremely drowsy/dizzy)—I was able to get in for 6 physical therapy sessions, which helped slightly. By the fall I had basically settled into daily moderate pain, punctuated here and there with episodes of severe pain. My daily activities and ability to sleep have never fully returned to the levels they were before last May, and at this point I feel chronically sleep-deprived. He literally (literally literally, not figuratively literally) shrugged when I told him this the last time I saw him several months ago and asked again whether I should see a specialist, get an MRI, etc.
[Aside re: other options for pain management: In the past 9 months I have also tried acupuncture (actually made things much, much worse), chiropractic (either does nothing or helps only slightly for a short period of time), myofascial release (helped a fair amount, but is not covered by my insurance and is very expensive, so I can’t afford to do it on an ongoing basis), and medical cannabis, in particular CBD oil (have tried different strains, edible vs. vaping, etc., and it has been very hit and miss; sometimes it helps a little, sometimes it does nothing, and other times it actually seems to amplify my pain awareness, but so far it has not really presented a solution).]
This past week, I felt the same pop in my neck, and have been in severe pain all over again. I recently started working with a personal trainer to try to build up some of the muscle tone I’ve lost over the past 9 months (being unable to exercise on my own without reinjuring myself), and she was very concerned and advised me to contact my doctor immediately. I emailed him and asked him again about a referral for an MRI and/or orthopedist. He said he would need to see me first, so now I’m waiting for an appointment to see him.
This has had—and I have said this to him in these exact words, more than once—a serious impact on my overall quality of life and productivity at work. I believe very strongly that my pain is being undertreated, possibly in part because of the opiate crisis and his concerns that I am drug-seeking, and possibly in part because I am a woman and he may be seeing me as being an unreliable narrator of my own experience.
QUESTION: what exactly should I do or say, at my next appointment, to maximize the chances of him taking me seriously? I feel like he's very good when it comes to assessing things that can be quantified by numbers (e.g., bloodwork to manage a completely unrelated chronic condition of mine, for which he's been the best doctor I’ve ever had), but is distinctly unable to empathize with issues that can’t be quantified in the same way (pain, anxiety, etc.). I have considered having my husband attend the appointment with me and/or bringing in a note from my boss to affirm that the pain has indeed been serious, ongoing, and disruptive (it sucks to feel like I need men to essentially act as witnesses to get another man to believe me, but here we are). I am willing to consider changing primary care physicians entirely if it comes to that, but that will take time (i.e., time to get it processed through the HMO, then time to get an appointment with a new doctor), and I am concerned that just the act of changing doctors could come across as doctor-shopping/drug-seeking, in which case I’d be in the same boat all over again.
Go to a different doctor, even on a second opinion basis. you shouldn't need to "switch" doctors at all.
posted by ArgentCorvid at 8:11 AM on February 9, 2018 [17 favorites]
posted by ArgentCorvid at 8:11 AM on February 9, 2018 [17 favorites]
It sucks, but I bet bringing your husband will make a difference.
posted by Snarl Furillo at 8:21 AM on February 9, 2018 [16 favorites]
posted by Snarl Furillo at 8:21 AM on February 9, 2018 [16 favorites]
Definitely go for the referral option.
Bringing someone with you is often a big help, even though it sucks to have to need to. Also, sometimes just that it's someone external is a thing: I had a diagnosis where a friend coming with me and saying what she'd noticed, and things that were entirely uncommon in her experience of me got me a referral. She was also great at continuing to push for what I really wanted out of that appointment, namely the referral, and kept redirecting my doctor at the time when I was frustrated by the conversation.
I've also had very good luck (not for pain issues, but for other things like exhaustion or other stuff that isn't measurable with blood work) with a "These are the things I was able to do before that I can't do now" lists - break it down to all the ordinary daily things. Bathing, getting dressed, cooking, commuting, impact on work, social life, anything you can think of.
Plus all the stuff you aren't doing because you have to go more slowly to avoid pain, or are too exhausted because pain. Like "We used to be able to do social activities X times a month, but for the past 9 months, it has been Many Fewer, because of the pain. I usually average Z sick days from work, in the past 9 months it has been 3 times as many, because pain." with numbers where they're relevant.
"Activities of daily living" is the term used in a lot of disability evaluation lists.
A bullet point list of what you've tried (maybe broken into 'this helped, but I can't continue it in this form', 'this was neutral' and 'this made it worse') can also help a lot when you get the referral.
posted by modernhypatia at 8:22 AM on February 9, 2018 [10 favorites]
Bringing someone with you is often a big help, even though it sucks to have to need to. Also, sometimes just that it's someone external is a thing: I had a diagnosis where a friend coming with me and saying what she'd noticed, and things that were entirely uncommon in her experience of me got me a referral. She was also great at continuing to push for what I really wanted out of that appointment, namely the referral, and kept redirecting my doctor at the time when I was frustrated by the conversation.
I've also had very good luck (not for pain issues, but for other things like exhaustion or other stuff that isn't measurable with blood work) with a "These are the things I was able to do before that I can't do now" lists - break it down to all the ordinary daily things. Bathing, getting dressed, cooking, commuting, impact on work, social life, anything you can think of.
Plus all the stuff you aren't doing because you have to go more slowly to avoid pain, or are too exhausted because pain. Like "We used to be able to do social activities X times a month, but for the past 9 months, it has been Many Fewer, because of the pain. I usually average Z sick days from work, in the past 9 months it has been 3 times as many, because pain." with numbers where they're relevant.
"Activities of daily living" is the term used in a lot of disability evaluation lists.
A bullet point list of what you've tried (maybe broken into 'this helped, but I can't continue it in this form', 'this was neutral' and 'this made it worse') can also help a lot when you get the referral.
posted by modernhypatia at 8:22 AM on February 9, 2018 [10 favorites]
Not that you're doing this, but I would warn you away from asking for specific drugs, particularly Dilaudid. For many physicians, for better or for worse, asking for Dilaudid by name immediately gives the impression you are a drug seeker.
I second modern hypatia's suggestions. If you can bring in a detailed log or documentation of what you have tried, when symptoms are worse, what other pain management you have tried, etc., that will build credibility in the provider's eyes. You'd be surprised at how many patients come in and can't state whether the pain started days, weeks, months or years ago.
I would consider switching to a new doctor. In the short term it is completely reasonable to seek a second opinion, especially given that you have been dealing with this for nine months. You should be able to see someone who can listen to you with less bias.
Good luck! Hope you can feel better soon.
posted by emkelley at 8:45 AM on February 9, 2018 [7 favorites]
I second modern hypatia's suggestions. If you can bring in a detailed log or documentation of what you have tried, when symptoms are worse, what other pain management you have tried, etc., that will build credibility in the provider's eyes. You'd be surprised at how many patients come in and can't state whether the pain started days, weeks, months or years ago.
I would consider switching to a new doctor. In the short term it is completely reasonable to seek a second opinion, especially given that you have been dealing with this for nine months. You should be able to see someone who can listen to you with less bias.
Good luck! Hope you can feel better soon.
posted by emkelley at 8:45 AM on February 9, 2018 [7 favorites]
Definitely find a new doctor who is a woman. I haven't had this kind of dismissive shit doled out by any of my female doctors, but definitely had it from male ones even over the most minor, non-dramatic stuff. Now only my dentist is male, and that's enough to put him on thin ice...
posted by Drosera at 8:46 AM on February 9, 2018 [26 favorites]
posted by Drosera at 8:46 AM on February 9, 2018 [26 favorites]
Two things: bring a man with you to the appointment, and see another doctor. Women are SO under-believed in this country when we present with pain. I'm a serious feminist and I realize that this is really gross and sad, but I have noticed that when I bring a man with me to medical appointments that somehow I'm taken more seriously then I ever am when I go alone.
I'm really sorry that you're going through this. You may need to see several different doctors in order to get somebody who takes you seriously.
One interesting thing that I read recently in a public survey about opioid use is that very few people are actually concerned that they themselves will get hooked on opiates. It was something like 7% of people have this worry. As such, I would keep that worry to myself if I were you when talking with a doctor. Honestly, most pain specialists don't prescribe opioids anymore, especially not as a first-line treatment.
posted by sockermom at 8:46 AM on February 9, 2018 [1 favorite]
I'm really sorry that you're going through this. You may need to see several different doctors in order to get somebody who takes you seriously.
One interesting thing that I read recently in a public survey about opioid use is that very few people are actually concerned that they themselves will get hooked on opiates. It was something like 7% of people have this worry. As such, I would keep that worry to myself if I were you when talking with a doctor. Honestly, most pain specialists don't prescribe opioids anymore, especially not as a first-line treatment.
posted by sockermom at 8:46 AM on February 9, 2018 [1 favorite]
Ps Seeing a woman doctor may not really help much. The last two women doctors that I've seen for my own pain were so dismissive I can't even begin to describe my interactions with them without boiling over in rage. The key thing to look for is somebody who practices what they call patient-centered care, that can help. But honestly you may just have to shop around until you find a doctor that takes you seriously.
posted by sockermom at 8:48 AM on February 9, 2018 [8 favorites]
posted by sockermom at 8:48 AM on February 9, 2018 [8 favorites]
The other thing you might try is putting the 'drug-seeking' issue out on the table, and asking him to find you a solution. "I understand that you don't want to prescribe opiate painkillers because you're afraid that I'm drug seeking. So we'll take it as understood that you're not going to. With that as an assumption: I'm in life-changing, constant pain; Tylenol does not relieve it; the NSAID you prescribed gave me severe stomach pain; [and going on through why the current situation is intolerable]. What can you do? If your answer is 'nothing', who can you refer me to who might be able to find some way to treat my pain?"
posted by LizardBreath at 8:53 AM on February 9, 2018 [24 favorites]
posted by LizardBreath at 8:53 AM on February 9, 2018 [24 favorites]
I second the advice to see a new doctor. I don't think you would need to pick a new primary care provider to do this. If your current doctor is part of a larger clinic, can you call reception and ask to see anyone who can see you ASAP? Or if online scheduling is available, pick a category of appointment that is clearly for the most urgent of cases and get in that way.
When you talk to the doctor, everyone on mefi usually recommends using the phrase "severely impacting my quality of life and daily activities." Don't ask about drugs at all--explain what you've taken and how it hasn't worked. Then ask a neutral sort of question like "What other options do I have for treating the pain while we figure out the cause of the pain?"
Also, as uncomfortable as it may be, practice the phrase "I would like a referral for an MRI." Don't ask if they think you need one, etc., just tell them this is what you want.
I have no doubt that you are being ignored because of misogyny. Among my friends with injuries/pain, the women have all had to do things like a whole year of PT before an MRI is ordered and reveals there's no cartilage in their knee while the men complain of a little twinge and immediately get all kinds of imaging done. It's maddening.
posted by purple_bird at 9:04 AM on February 9, 2018 [14 favorites]
When you talk to the doctor, everyone on mefi usually recommends using the phrase "severely impacting my quality of life and daily activities." Don't ask about drugs at all--explain what you've taken and how it hasn't worked. Then ask a neutral sort of question like "What other options do I have for treating the pain while we figure out the cause of the pain?"
Also, as uncomfortable as it may be, practice the phrase "I would like a referral for an MRI." Don't ask if they think you need one, etc., just tell them this is what you want.
I have no doubt that you are being ignored because of misogyny. Among my friends with injuries/pain, the women have all had to do things like a whole year of PT before an MRI is ordered and reveals there's no cartilage in their knee while the men complain of a little twinge and immediately get all kinds of imaging done. It's maddening.
posted by purple_bird at 9:04 AM on February 9, 2018 [14 favorites]
Call your HMO, complain and get an immediate referral however they do that.
Stop asking for pain meds, focus on the pop in your neck and tell them you need diagnosis and treatment for your injury asap.
Next time, escalate immediately if you do not receive proper tests and diagnosis. What good did waiting do you?
posted by jbenben at 9:21 AM on February 9, 2018 [5 favorites]
Stop asking for pain meds, focus on the pop in your neck and tell them you need diagnosis and treatment for your injury asap.
Next time, escalate immediately if you do not receive proper tests and diagnosis. What good did waiting do you?
posted by jbenben at 9:21 AM on February 9, 2018 [5 favorites]
Document everything. Pain levels (1-10) during the day, when you take the pain killers they prescribed what you've done the day when it hurts more, when it hurts less etc. Does heat help the pain, cold packs? Laying down, sitting up? What you were doing on a day of bad pain vs on a day of less pain. What couldn't you do that day because of pain?
Find a new doctor. Don't just tell them you are there because you hurt. Tell them you are there because you have a problem you wish to solve, that you want to see a specialist if they can't help & provide them with all the information you have Insist if they aren't going to provide you with pain relief, then what are they going to do to help you? Can they give you something to stop the pain tablets they've given you from giving you stomach pain? Because currently you are unable to do xyz and are having pain x hours a day. Refer again to your notes.
Make notes of everything you want to say before you go, clearly go through the list until you have answers. Make notes of the responses. Doctors tend to be more thoughtful about what they say if you are writing it down.
posted by wwax at 9:22 AM on February 9, 2018
Find a new doctor. Don't just tell them you are there because you hurt. Tell them you are there because you have a problem you wish to solve, that you want to see a specialist if they can't help & provide them with all the information you have Insist if they aren't going to provide you with pain relief, then what are they going to do to help you? Can they give you something to stop the pain tablets they've given you from giving you stomach pain? Because currently you are unable to do xyz and are having pain x hours a day. Refer again to your notes.
Make notes of everything you want to say before you go, clearly go through the list until you have answers. Make notes of the responses. Doctors tend to be more thoughtful about what they say if you are writing it down.
posted by wwax at 9:22 AM on February 9, 2018
An ER visit might also get you an immediate MRI? But again, less focus on the pain meds and more focus on the cause.
posted by jbenben at 9:23 AM on February 9, 2018
posted by jbenben at 9:23 AM on February 9, 2018
But don't agree to steroid shots! They do nothing to help and can cause serious harm ! Lots of studies on Google scholar and a recent, strongly worded, FDA advisory about them.
posted by fshgrl at 9:27 AM on February 9, 2018 [3 favorites]
posted by fshgrl at 9:27 AM on February 9, 2018 [3 favorites]
Back pain is notoriously difficult to treat. Even if you're seeing a doctor who isn't dismissive, it can take a long time to pinpoint the problem and get the pain under control. I'm nthing all the other comments that say you should see another doctor. AND the ones that assert this is due to misogyny/sexism. I just don't see anything in his treatment of you that would warrant continuing to run into that brick wall.
When I had 24/7/365 heavy bleeding and abdominal pain due to fibroids and adenomyosis, my (female) gyn refused to do a hysterectomy even though I was 40 and never wanted kids. ("You might change your mind.") When I found a new gyn, I said at my first appointment "I left my last gyn because she refused to do a hysterectomy even though I believe it's medically indicated. I am ruining bed sheets and work clothes. I am doubled over in pain. I am drinking too much because I have no adequate pain control. I want a hysterectomy. If you're not willing to entertain that as a solution, then we can call this our first and last appointment and I will be on my way." And she was wonderful and I got my surgery, and all is well. I did much the same thing with my years long back pain as well, switching docs several times until I found one that did the right imaging to correctly diagnose the problem.
You have the right to have your pain controlled. You deserve not to have to beg your doctor for help.
posted by ImproviseOrDie at 9:34 AM on February 9, 2018 [15 favorites]
When I had 24/7/365 heavy bleeding and abdominal pain due to fibroids and adenomyosis, my (female) gyn refused to do a hysterectomy even though I was 40 and never wanted kids. ("You might change your mind.") When I found a new gyn, I said at my first appointment "I left my last gyn because she refused to do a hysterectomy even though I believe it's medically indicated. I am ruining bed sheets and work clothes. I am doubled over in pain. I am drinking too much because I have no adequate pain control. I want a hysterectomy. If you're not willing to entertain that as a solution, then we can call this our first and last appointment and I will be on my way." And she was wonderful and I got my surgery, and all is well. I did much the same thing with my years long back pain as well, switching docs several times until I found one that did the right imaging to correctly diagnose the problem.
You have the right to have your pain controlled. You deserve not to have to beg your doctor for help.
posted by ImproviseOrDie at 9:34 AM on February 9, 2018 [15 favorites]
Does your employer have an EAP (Employee Assistance Program)? They might be a useful resource.
Read the HMO information. They may have medical staff you can call for help. They could approve visits to other specialists and treatments, depending on your contract.
I wish you the best.
posted by theora55 at 9:35 AM on February 9, 2018
Read the HMO information. They may have medical staff you can call for help. They could approve visits to other specialists and treatments, depending on your contract.
I wish you the best.
posted by theora55 at 9:35 AM on February 9, 2018
A friend of mine wrote up "how to talk with doctors when you need pain medications" on tumblr. (Not a link to the original author's blog, which has a lot of NSFW content and I'm not sure how readable the layout is.)
Never actually say “I really need strong drugs here doctor, because the drugs you and every other doctor gave me for this injury/illness didn’t work, and also I’ve been in pain for years and I’d like that to stop.”posted by ErisLordFreedom at 9:43 AM on February 9, 2018 [8 favorites]
...
Try this:
“Well, I hate these drugs that make me *stupid*, you know? One of these so-called doctors — they gave me some pill that made me feel like I was on a whole separate planet for *years*, but I was still in pain! I have things to *do*, doctor. I have a job/family/projects. I wouldn’t be here if I could get my work done the way I am now, but if I can’t do them with the drugs you give me, then what’s the point?”
Make sure to translate this into the appropriate dialect for your area, but note the important points:
a) Reassures the doctor that you’re not one of those ~*eeevil*~ junkies.
b) Reassures the doctor that you’re not one of those ~*eeevil*~ non-productive members of society.
c) Reassures the doctor that you’re not one of those ~*eeevil*~ weak-willed disabled people.
Some of this has to do with nonverbal information you are presenting to the doctor. This unfortunately includes things like gender, class and race, but it also has to do with your affect, past medical history and history of help-seeking behavior, how you talk about the pain and whether you are simply describing the pain or asking for a specific treatment. It is often a red flag when patients ask for specific treatments or tests, and that leads doctors to be much more reluctant to write for pain medications. I've also seen patients use the script above that ErisLordFreedom posted about vehemently stating an aversion to the side effects of pain medications as a way to underscore their non-drug-seeking behavior, but that can actually also backfire as a red flag.
Your complaint may be more compelling to your doctor if you can explain, in more concrete terms, how the pain has affected your level of functioning. For example, if the pain is interfering with lifting a watering can while gardening, that is generally more helpful to the doctor than telling them that the pain is debilitating or interfering with your ability to work, which is a little too nonspecific and phrases/terms that many patients use liberally. Ditto with pain ratings of 10/10.
This may be an unpopular opinion, but personally, I would not switch doctors. You want the same doctor to see you through the progression of your back pain -- that way if it does get worse, he can review his own notes (which he will always trust more) and have a better-calibrated sense of what could be going on, and order more treatment and imaging as appropriate. Back pain is frustrating and challenging to treat, and I'm so sorry that you've had such a hard time with it. However, on the bright side, oftentimes it is self-limiting and not due to any serious underlying issue. Conservative treatment is the mainstay approach. A doctor who has just met you who is willing to prescribe you pain medications or order a MRI may be taking the easier route, which risks doing you more harm. IANYD, this is not medical advice, etc.
posted by gemutlichkeit at 10:08 AM on February 9, 2018
Your complaint may be more compelling to your doctor if you can explain, in more concrete terms, how the pain has affected your level of functioning. For example, if the pain is interfering with lifting a watering can while gardening, that is generally more helpful to the doctor than telling them that the pain is debilitating or interfering with your ability to work, which is a little too nonspecific and phrases/terms that many patients use liberally. Ditto with pain ratings of 10/10.
This may be an unpopular opinion, but personally, I would not switch doctors. You want the same doctor to see you through the progression of your back pain -- that way if it does get worse, he can review his own notes (which he will always trust more) and have a better-calibrated sense of what could be going on, and order more treatment and imaging as appropriate. Back pain is frustrating and challenging to treat, and I'm so sorry that you've had such a hard time with it. However, on the bright side, oftentimes it is self-limiting and not due to any serious underlying issue. Conservative treatment is the mainstay approach. A doctor who has just met you who is willing to prescribe you pain medications or order a MRI may be taking the easier route, which risks doing you more harm. IANYD, this is not medical advice, etc.
posted by gemutlichkeit at 10:08 AM on February 9, 2018
I would try to accept that your doctor may be looking out for your best long-term interests, rather than assuming he's suspicious and trying to deny you proper care
A doctor who really felt that way (but see fshgirl's point) would not have addressed the issue with an abrupt "that's not appropriate." He would have explained the risks and limitations of such medication and outlined what treatment approaches would be preferable to take first. A doctor who jumps instantly to the conclusion that you're a drug-seeker will never treat you properly (whatever the correct treatment might be).
posted by praemunire at 10:45 AM on February 9, 2018 [8 favorites]
A doctor who really felt that way (but see fshgirl's point) would not have addressed the issue with an abrupt "that's not appropriate." He would have explained the risks and limitations of such medication and outlined what treatment approaches would be preferable to take first. A doctor who jumps instantly to the conclusion that you're a drug-seeker will never treat you properly (whatever the correct treatment might be).
posted by praemunire at 10:45 AM on February 9, 2018 [8 favorites]
As unsatisfying as it feels, he treated you appropriately for acute back pain initially. The treatment is NSAIDs, tylenol, staying active and physical therapy. These are the guidelines. Yes, back pain is excruciating, and no chronic opioid treatment is not the answer. I would avoid being accusatory, i.e. implying he didn't treat you correctly. The fact that you didn't get better after his initial treatment should prompt him to do something else if you keep bringing it up as a major problem for you. I agree you should give concrete examples of how this has affected your life and limited what you are able to do specifically.
If you did get an MRI, I'd bet a lot of money that it will show... something. It almost always does. And I'm sure you could find a surgeon out there do some intervention. But there has been a lot of evidence indicating that spine surgery often makes things worse rather than better. I would avoid it at all costs, personally.
posted by bobobox at 10:50 AM on February 9, 2018 [4 favorites]
If you did get an MRI, I'd bet a lot of money that it will show... something. It almost always does. And I'm sure you could find a surgeon out there do some intervention. But there has been a lot of evidence indicating that spine surgery often makes things worse rather than better. I would avoid it at all costs, personally.
posted by bobobox at 10:50 AM on February 9, 2018 [4 favorites]
Mod note: Couple things removed. I need y'all to cut it out with the back-and-forth jousting pronto.
posted by cortex (staff) at 11:15 AM on February 9, 2018
posted by cortex (staff) at 11:15 AM on February 9, 2018
1) FIND A NEW DOCTOR (GP)
I cannot stress this enough. Some doctors are SHIT and there is nothing you can do to change this. A lot of it lies in sexism. Preferably find a woman though I have had good male doctors as well, including my endometriosis surgeon and OBGYN.
1a) HOW??
Ask friends, and do your research. Search the doctor's name and "review" and they will link to review sites, sometimes on the hospital's page itself. Now, many people only review stuff if they have a BAD experience, however my experience has been that with doctors, people also review if they have an AMAZING experience. All of my doctors have stellar online reviews all across the internet.
1b) EVALUATE:
How do they talk to you? Do they listen? What advice to they offer? Are they suggesting anything to suggest your pain may not be real, may be because your "anxious" or "depressed" etc. If they don't have an answer they should recommend someone who might, not just leave you with nothing.
If they just throw pills at you but can't tell you WHY that is the only option or WHY that his happening, then get a new doctor. For example, I have chronic conditions that have no cure and limited treatments. So when treatments are suggested to me, my doctors have told me why they are giving me the treatments and that other lines of treatment or illness have been ruled out.
1c) TAKE A MALE WITH YOU (optional)
I have had doctors literally talk to my husband in front of me and believe HIM when he repeated my symptoms. My husband didn't really understand just how dismissive doctors were of me until he was in the room.
Now, I say this is optional because I ain't got time for a shitty sexist doctor. That means you may have to doctor shop, but in the long run it's usually best because you will find someone who supports you regardless of if a male is in a room. Perhaps I recommend it for a specialist or something that you can't "shop around" for. I also understanding people are restricted by time and insurance and may not have a good choice of doctors. But for a GP, I'm so fucking over that shit that I refuse to give sexists doctors my time or money whenever possible.
1d) SPECIALISTS
Similar to finding a good GP, you can do the same for specialists. But know that often you will need a recommendation and things tend to work faster through a GP first as they can order a lot of basic testing to help you figure out what type of specialist you need to see. Often, specialists don't "see" disorders outside of their field. They are a hammer and everything is a nail. For example I have endometriosis and no GI doctor ever suggested anything other than IBS even though my pain corresponded with my period. I have endometriosis too.
If you find a GP you like, as them for specialist recommendations. I mentioned my issues with GI doctors and how many of them didn't believe me or didn't help. My GP rolled her eyes and sighed and said, "Yeah, I know EXACTLY who to send you to because he's amazing." And he is amazing. I literally almost cried in his office and he was the first GI to actually help me.
2) ADVOCATE FOR YOURSELF
This is hard shit. Realize, doctors are people. They are NOT all knowing beings. YOU are the patient who should be treated with respect and they are there to HELP you and if they aren't doing that, then they aren't worth your time. Stand up for yourself, ask questions, don't get brushed off.
2a) BRING NOTES
It's really good to track symptoms and take notes with you so that you ask all the questions you want to ask and you can write down answers. It also helps you advocate for yourself instead of being brushed off or intimidated.
2b) HOW TO TALK ABOUT IT
You HAVE to be honest and open and actually hammer it in that THIS IS A PROBLEM. As women we are taught to not make a fuss or be "dramatic". So we have to walk this fine line of making out problems KNOWN. Explain them in a clear manner while detailing how severe they are.
Phrases include:
"This is affecting my quality of life in a severe way because..."
"I am not able to do normal things I was once able to do such as..."
"The pain is so severe that ...."
"No other treatments have helped and when I have tried them they ...."
"I am routinely in pain for X amount of time every X period."
"The pain feels like...."
"When I do X or Y the pain gets [better] or [worse]."
"The pain has been going on for Xtime and started with ...."
3) BE YOUR OWN DOCTOR
Okay, doctors hate this - EXCEPT good doctors. But you HAVE to understand your own body too. That means getting copies of your test results and doing your own research.
3a) CHECK YOUR RESULTS AND RESEARCH
Now, the internet can be shitty. The joke is that everything says it's cancer. But you have to rule in and out things. For example it's likely not your appendix that's causing your pain. So research within areas that seem compatible and ask around.
I was told by one doctor my gallbladder was "normal" only to check results myself, take them to my regular doctor when she was back from leave, and end up in surgery 2 weeks later. I discovered other conditions from asking online and having people with similar symptoms tell me their conditions. (POTS). Not everything I brought up was correct, but much of it was. And my amazing doctor with trust me and do the tests or say "You know, I don't think that's feasible because of X, Y, Z" When I first went to her I suggested it may be my thyroid since symptoms matched. When my test was negative she said, "You know, I thought you'd be right and it would be your thyroid too." She didn't brush me off for doing my own research. You have to be your own doctor in a lot of this, unfortunately, and double check everything.
3b) A FRIEND TOLD ME...
I have used "a friend told me" or "a friend has X condition" or "My mother in law who is a nurse wanted me to get X checked" or "my understanding about this condition is.." when what I really meant was "I researched this for hours on my own and know what I'm talking about too."
4) DON'T GIVE UP
This shit is HARD. I've been sick for over 5 years and left my job 3 years ago. It took me YEARS to find answers. But don't give up. Realize that everytime something comes back "normal" it's a step closer to finding an answer.
5) GET SUPPORT
Make sure there are people around you to help you emotionally and physically. A spouse, a sibling, a friend. I also highly recommend seeing a therapist because this shit is really hard to deal with.
Please know that I'm always here to chat about health shit. I also am active on Instagram and talk about it there too. There's a large community of people online with chronic pain.
Source: Chronically ill young woman who has struggled for years. I have seen probably between 15 to 20 doctors with only about 3 or 4 that have been good and many that have dismissed me because I am a woman and "look healthy."
posted by Crystalinne at 2:25 PM on February 9, 2018 [10 favorites]
I cannot stress this enough. Some doctors are SHIT and there is nothing you can do to change this. A lot of it lies in sexism. Preferably find a woman though I have had good male doctors as well, including my endometriosis surgeon and OBGYN.
1a) HOW??
Ask friends, and do your research. Search the doctor's name and "review" and they will link to review sites, sometimes on the hospital's page itself. Now, many people only review stuff if they have a BAD experience, however my experience has been that with doctors, people also review if they have an AMAZING experience. All of my doctors have stellar online reviews all across the internet.
1b) EVALUATE:
How do they talk to you? Do they listen? What advice to they offer? Are they suggesting anything to suggest your pain may not be real, may be because your "anxious" or "depressed" etc. If they don't have an answer they should recommend someone who might, not just leave you with nothing.
If they just throw pills at you but can't tell you WHY that is the only option or WHY that his happening, then get a new doctor. For example, I have chronic conditions that have no cure and limited treatments. So when treatments are suggested to me, my doctors have told me why they are giving me the treatments and that other lines of treatment or illness have been ruled out.
1c) TAKE A MALE WITH YOU (optional)
I have had doctors literally talk to my husband in front of me and believe HIM when he repeated my symptoms. My husband didn't really understand just how dismissive doctors were of me until he was in the room.
Now, I say this is optional because I ain't got time for a shitty sexist doctor. That means you may have to doctor shop, but in the long run it's usually best because you will find someone who supports you regardless of if a male is in a room. Perhaps I recommend it for a specialist or something that you can't "shop around" for. I also understanding people are restricted by time and insurance and may not have a good choice of doctors. But for a GP, I'm so fucking over that shit that I refuse to give sexists doctors my time or money whenever possible.
1d) SPECIALISTS
Similar to finding a good GP, you can do the same for specialists. But know that often you will need a recommendation and things tend to work faster through a GP first as they can order a lot of basic testing to help you figure out what type of specialist you need to see. Often, specialists don't "see" disorders outside of their field. They are a hammer and everything is a nail. For example I have endometriosis and no GI doctor ever suggested anything other than IBS even though my pain corresponded with my period. I have endometriosis too.
If you find a GP you like, as them for specialist recommendations. I mentioned my issues with GI doctors and how many of them didn't believe me or didn't help. My GP rolled her eyes and sighed and said, "Yeah, I know EXACTLY who to send you to because he's amazing." And he is amazing. I literally almost cried in his office and he was the first GI to actually help me.
2) ADVOCATE FOR YOURSELF
This is hard shit. Realize, doctors are people. They are NOT all knowing beings. YOU are the patient who should be treated with respect and they are there to HELP you and if they aren't doing that, then they aren't worth your time. Stand up for yourself, ask questions, don't get brushed off.
2a) BRING NOTES
It's really good to track symptoms and take notes with you so that you ask all the questions you want to ask and you can write down answers. It also helps you advocate for yourself instead of being brushed off or intimidated.
2b) HOW TO TALK ABOUT IT
You HAVE to be honest and open and actually hammer it in that THIS IS A PROBLEM. As women we are taught to not make a fuss or be "dramatic". So we have to walk this fine line of making out problems KNOWN. Explain them in a clear manner while detailing how severe they are.
Phrases include:
"This is affecting my quality of life in a severe way because..."
"I am not able to do normal things I was once able to do such as..."
"The pain is so severe that ...."
"No other treatments have helped and when I have tried them they ...."
"I am routinely in pain for X amount of time every X period."
"The pain feels like...."
"When I do X or Y the pain gets [better] or [worse]."
"The pain has been going on for Xtime and started with ...."
3) BE YOUR OWN DOCTOR
Okay, doctors hate this - EXCEPT good doctors. But you HAVE to understand your own body too. That means getting copies of your test results and doing your own research.
3a) CHECK YOUR RESULTS AND RESEARCH
Now, the internet can be shitty. The joke is that everything says it's cancer. But you have to rule in and out things. For example it's likely not your appendix that's causing your pain. So research within areas that seem compatible and ask around.
I was told by one doctor my gallbladder was "normal" only to check results myself, take them to my regular doctor when she was back from leave, and end up in surgery 2 weeks later. I discovered other conditions from asking online and having people with similar symptoms tell me their conditions. (POTS). Not everything I brought up was correct, but much of it was. And my amazing doctor with trust me and do the tests or say "You know, I don't think that's feasible because of X, Y, Z" When I first went to her I suggested it may be my thyroid since symptoms matched. When my test was negative she said, "You know, I thought you'd be right and it would be your thyroid too." She didn't brush me off for doing my own research. You have to be your own doctor in a lot of this, unfortunately, and double check everything.
3b) A FRIEND TOLD ME...
I have used "a friend told me" or "a friend has X condition" or "My mother in law who is a nurse wanted me to get X checked" or "my understanding about this condition is.." when what I really meant was "I researched this for hours on my own and know what I'm talking about too."
4) DON'T GIVE UP
This shit is HARD. I've been sick for over 5 years and left my job 3 years ago. It took me YEARS to find answers. But don't give up. Realize that everytime something comes back "normal" it's a step closer to finding an answer.
5) GET SUPPORT
Make sure there are people around you to help you emotionally and physically. A spouse, a sibling, a friend. I also highly recommend seeing a therapist because this shit is really hard to deal with.
Please know that I'm always here to chat about health shit. I also am active on Instagram and talk about it there too. There's a large community of people online with chronic pain.
Source: Chronically ill young woman who has struggled for years. I have seen probably between 15 to 20 doctors with only about 3 or 4 that have been good and many that have dismissed me because I am a woman and "look healthy."
posted by Crystalinne at 2:25 PM on February 9, 2018 [10 favorites]
Get another doctor. This one is going to fight you every step of the way. You need someone who will take an MRI. I had to fight my sports medicine doctor for two years to get an MRI, and lo and behold, I had a spinal cord injury that he had previously dismissed as a little arthritis, based on the X-Ray.
With the next doctor, present exactly what happened, and when. Instead of asking for opioids or the like, tell your next doctor that you have heard good things about gabapentin, Cymbalta and Lyrica for pain relief originating in the neck and spine. None of those are opioids and they are very effective in managing nerve pain.
You might also ask if a short course of prednisone or a similar steroid might help-- if everything is inflamed from being irritated, the steroids can help with that a LOT. Personally, I found that opioids do *nothing* for the pain that originates from my spine and neck, which may be why your current doctor is so all-fired against them. BUT, he shouldn't be against finding SOMETHING that makes you feel better.
So screw that guy. Get a better opinion. I hope you feel better soon.
posted by headspace at 2:29 PM on February 9, 2018 [1 favorite]
With the next doctor, present exactly what happened, and when. Instead of asking for opioids or the like, tell your next doctor that you have heard good things about gabapentin, Cymbalta and Lyrica for pain relief originating in the neck and spine. None of those are opioids and they are very effective in managing nerve pain.
You might also ask if a short course of prednisone or a similar steroid might help-- if everything is inflamed from being irritated, the steroids can help with that a LOT. Personally, I found that opioids do *nothing* for the pain that originates from my spine and neck, which may be why your current doctor is so all-fired against them. BUT, he shouldn't be against finding SOMETHING that makes you feel better.
So screw that guy. Get a better opinion. I hope you feel better soon.
posted by headspace at 2:29 PM on February 9, 2018 [1 favorite]
definitely find a new doctor, this guy sounds like he's not going to move away from his stupid assumptions about you. you should probably see an orthopedist but in the long term, pain management doctors are not just prescription-writers for opiates, there's like a dozen things to try before opiates.
i agree w/headspace above that something like prednisone could have excellent effects on your acute incidents of pain (when you feel the popping sensation). it can occasionally have some intense side effects involving mood/emotions so if you already have anxiety etc be prepared for a potential spike.
most importantly DO NOT SEE A CHIROPRACTOR FOR NECK PAIN. ever. full stop. see a real doctor who is not a charlatan that could kill you with ill-conceived "adjustments".
posted by poffin boffin at 2:57 PM on February 9, 2018 [3 favorites]
i agree w/headspace above that something like prednisone could have excellent effects on your acute incidents of pain (when you feel the popping sensation). it can occasionally have some intense side effects involving mood/emotions so if you already have anxiety etc be prepared for a potential spike.
most importantly DO NOT SEE A CHIROPRACTOR FOR NECK PAIN. ever. full stop. see a real doctor who is not a charlatan that could kill you with ill-conceived "adjustments".
posted by poffin boffin at 2:57 PM on February 9, 2018 [3 favorites]
Crystalinne's advice is really good.
I'm a professional in the disability field and I have chronic pain from rheumatoid arthritis. Here is what I recommend.
Get a new provider. Some providers do not prescribe narcotics, full stop. That's fine, though they should refer you to a pain care specialist if they are not comfortable providing that sort of care - there's a big space between "I don't do that, you need to see someone who does" and "I'm not listening to you." This provider is not listening to you about pain, or why you're in pain, or what happened, and that's not acceptable. See someone new. Ask around for who is more reasonable - do not stay with the same clinic, because they'll have this guy's negative notes on you.
Before you go in, make a list. When did the neck popping events happen? What happened afterward? Right afterward, a few hours, that night, the next few days? Describe your limitations in as much detail as you can - is it impacting your sleep? Bending? Reaching overhead? Walking? Standing? Slinging your bag over that arm? How are your arms and hands? How is your grip? What helps? What makes it worse? Different weather? Sitting for long periods? Make as thorough a list as you can.
When you go in, dress a little nice - if your job is a business casual kind of job, wear that - and emphasize that you're a responsible adult and can't have this interfering in your life because you have to do things, and that while your boss has been kind this is impacting you at work and you are very concerned about that. Be polite. It's okay to cry about this but getting angry won't help. Don't badmouth your prior provider, but let the new person know that you felt you weren't being listened to, they were dismissive of your symptoms, and wouldn't order any testing even after the event repeated and you are frustrated about it.
Once this comes up, be clear that while you don't want to be on pain medication in the long term, you do need to function and work and get through your day, and that's when you talk about the other things that haven't helped, and that you really want to get whatever testing or imaging is appropriate, but you need to work and sleep in the meantime.
Please do not go in and go on about how you're not like those other people seeking pain meds, you know, the bad ones. Focus on you, not other people - this isn't about the so-called opiate crisis and you don't want to bring that up. This is about that your neck made a horrible popping sound and now it hurts horribly and you need it to stop.
posted by bile and syntax at 5:19 PM on February 9, 2018 [3 favorites]
I'm a professional in the disability field and I have chronic pain from rheumatoid arthritis. Here is what I recommend.
Get a new provider. Some providers do not prescribe narcotics, full stop. That's fine, though they should refer you to a pain care specialist if they are not comfortable providing that sort of care - there's a big space between "I don't do that, you need to see someone who does" and "I'm not listening to you." This provider is not listening to you about pain, or why you're in pain, or what happened, and that's not acceptable. See someone new. Ask around for who is more reasonable - do not stay with the same clinic, because they'll have this guy's negative notes on you.
Before you go in, make a list. When did the neck popping events happen? What happened afterward? Right afterward, a few hours, that night, the next few days? Describe your limitations in as much detail as you can - is it impacting your sleep? Bending? Reaching overhead? Walking? Standing? Slinging your bag over that arm? How are your arms and hands? How is your grip? What helps? What makes it worse? Different weather? Sitting for long periods? Make as thorough a list as you can.
When you go in, dress a little nice - if your job is a business casual kind of job, wear that - and emphasize that you're a responsible adult and can't have this interfering in your life because you have to do things, and that while your boss has been kind this is impacting you at work and you are very concerned about that. Be polite. It's okay to cry about this but getting angry won't help. Don't badmouth your prior provider, but let the new person know that you felt you weren't being listened to, they were dismissive of your symptoms, and wouldn't order any testing even after the event repeated and you are frustrated about it.
Once this comes up, be clear that while you don't want to be on pain medication in the long term, you do need to function and work and get through your day, and that's when you talk about the other things that haven't helped, and that you really want to get whatever testing or imaging is appropriate, but you need to work and sleep in the meantime.
Please do not go in and go on about how you're not like those other people seeking pain meds, you know, the bad ones. Focus on you, not other people - this isn't about the so-called opiate crisis and you don't want to bring that up. This is about that your neck made a horrible popping sound and now it hurts horribly and you need it to stop.
posted by bile and syntax at 5:19 PM on February 9, 2018 [3 favorites]
Everyone's experience is different, but as a data point, mine has been that when I dressed business casual (because I had to work after the appointment) I was taken LESS seriously than when I wore a plain t shirt, no makeup, and jeans. I appeared "Healthy" because I could button a shirt apparently. I didn't dress like a slob, but just like I was in pain, which I was. And I was taken more seriously like that.
posted by Crystalinne at 9:10 PM on February 9, 2018 [2 favorites]
posted by Crystalinne at 9:10 PM on February 9, 2018 [2 favorites]
I am also a middle aged woman with chronic neck pain. However, I had no problem getting my primary and specialist doctors to authorize MRIs to diagnose the cause of my pain. I confess I haven't read all the other responses you received here, so perhaps I missed something? How in the world could your doctor arbitrarily decide you don't need an MRI?? Granted, it's a relatively costly diagnostive, but it is also incredibly common because it IS needed, and efficient. My MRI showed fairly serious disc problems from c4 thru c7, including bulges and stenosis, and they were not caused by an injury... just degenerative. I also had a pinched nerve. Regular old xrays would not have found these problems. You absolutely need another doctor who will approve an MRI. As for your attempts to get narcotic pain medication, I have 2 things to say about that: first, without a clear picture of what is going on in your neck, no reputable doctor SHOULD prescribe opioids, muscle relaxers or even nerve pain meds like Gabapentin or Lyrica. Asking for such prescriptions is putting the cart before the horse. I realize your pain is real or it is unlikely you would be on this forum. But you must try everything to find the cause. Next, as others have said, you automatically raise a doctor's suspicions when you come into an appointment complaining that you need strong painkillers. Did you have opioids in an ER visit and feel relief? If so, did the ER do an MRI? If so, you should definitely take those films and/or reports to your current doctor or to a new doctor. This is the first step in receiving the medicinal help you need. Of course, there is the possibility that an MRI will not show significant damage and you would, again, be in the unfortunate position of suffering chronic pain due to an undetermined cause. Finally, as you might know, most chronic pain patients in the US are not given opioids by primary care docs or specialists but are referred to pain management clinics. Even so, many pain clinics are also loathe to prescribe narcotics if more conservative treatments are appropriate. I do receive multiple painkiller prescriptions from my current clinic and, yes, I get relief. But after 2 surgeries, these drugs seem more like putting a bandage on a gaping wound than a real remedy. I wish you well in your search for relief. Chronic pain sucks.
posted by Jacqline at 2:48 PM on February 15, 2018
posted by Jacqline at 2:48 PM on February 15, 2018
This thread is closed to new comments.
Most doctors don't like to prescribe opiate painkillers for chronic neck and back pain - but what you have sounds like an acute injury. You need to find out what's going on in there. I would approach it from that perspective first: I need your help in getting a referral to an orthopedic specialist who can help me diagnose and fix this debilitating problem with my neck.
After you've gotten a referral, then you can say: I need some relief from this pain until my specialist appointment. I am aware of the risk of long-term opiate usage and that's not what I'm interested in, but what can you prescribe to get me through the intervening time until my specialist appointment?
posted by something something at 8:10 AM on February 9, 2018 [7 favorites]