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one woman’s experience with a good pain doctor
As I write this, an intense pain is beginning to throb behind my right eye. I gave myself a shot of Imitrex, a non-narcotic vasoconstrictor two hours ago but the injections only provide me with two hours of relief and the pain is returning. One can only have two injections in a 24-hour period so if the pain returns, and it does three out of four times, I need relief for the 20 remaining hours. I’ve had migraines for 34 years and during that time I have been to countless clinicians — conventional, alternative and combinations of both. I have been prescribed every category of drug that has a record of treating migraines, either in double blind studies or anecdotally, both on-label and off-label and too many herbs, elimination diets, “therapeutic” diets, supplements and non medical therapeutics to recount here. Out of all of the above, only one thing ever worked preventively: the blood pressure pill Inderal. For three months I was migraine-free. And then they came back, if not with a vengeance, with disappointing regularity. The doctor tried upping the dose and kept upping it until I was so lethargic I could barely get out of bed in the morning. High doses made no difference. That was 25 years ago. Since then, years of trial and error, mostly error, have resulted in pain more days than not.Despite that, life has been fine for the past six years because I’ve been under the care of a pain doctor. He’s the opposite of the money-hungry doctors who operated the once unregulated pill mills in Florida (see my last blog post). He knows my past, he monitors my present and offers me hope for the future. Not hope that he can make the migraines goes away. Hope that as long as I’m in his care, there will be someone who will be committed to keeping my pain at a tolerable level so that I can work, play and sleep. That kind of hope is no small thing.
He keeps careful records of what I eat, what supplements I take, how much I work, how much I sleep, the quantity and quality of the relationships I have, the degree to which pain keeps me housebound (since seeing him, almost never.) He helps me fine-tune painkillers so that I take the minimum required to alleviate the pain while enabling me to continue functioning. One of the benefits of seeing him: pain patients in his care often share techniques that have helped them. The mother of one patient even sewed a dozen little rice-filled satchels that could be cooled or heated and then applied to painful areas of the head, neck and back. This sharing engenders a feeling of community that makes this life a little less lonely.
I have accepted that, like my mother and my sister, I have a condition that will most likely be with me for the rest of my life. The only time I get depressed about this fact is when I read articles that suggest pain doctors who prescribe what the DEA considers excessive numbers of pain killers may lose their licenses or worse, be sent to prison. Oh yes, there’s one other thing that depresses me: when a physician at my HMO tries some new promising approach and that promising approach doesn’t work. The last episode was a neurologist injecting BOTOX in my scalp and neck. I was left with slight bruising to my skin, no change in the number or intensity of my migraines but major bruising to my spirit.
Pain patients are susceptible to depression. According to Webmd, one-quarter to more than half of patients who complain of pain to their physicians are depressed. There are various theories as to why the two are linked — some of the reasons are obvious, some not, but in my experience, it isn’t difficult to make people with intractable pain feel worse than they already feel. We suspect that it’s a failure of character not only to be in pain, but to be resistant to so many techniques to eliminate it – techniques that work with other people, people who, undoubtedly, are morally superior. Being under the care of a doctor who understands pain and the toll it takes, makes all the difference. The migraines continue to be unpredictable. What has been predictable: is the knowledge that I will have access to medication that will dull the pain. Those of us who have been lucky enough to find such a clinician feel lucky. But now, after years of stability, it sometimes feels that the bottom is about to fall out of pain treatment.
The pain behind my eye is now on the intolerable side of intense but I will save the second injection of Imitrex for bedtime to assure a night’s sleep. I’ll get through the hours between now and then because I am, for now, one of the lucky ones – the kind of luck that’s as essential to my life as insulin is to a diabetic. Opiates will dull the pain so that I can finish the chapter of the book I’m working on, walk the dog and prepare dinner for my husband. Will such a rescue be possible next week? Next month? Next year? Only the DEA knows for sure.
[My pain doctor, Dr. Forrest Tennant, has a great website with helpful resources for pain management: www.foresttennant.com]
