My letter from pain clinic to my g.p

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The following is my letter from the pain clinic to my G.P

Please can I have all your thoughts....

Dear Dr foster

Thanks for askng us to see Marc. He comes complaining of widespread pain for the past year or so. He said he began attending yourselves about the pain around four or five months ago. He describes pain in the hips, knees, thighs, and ankles, the neck to the shoulders and from the elbows down to the wrists, low back and buttock bilaterally. He described the pain as "tight" and "tense". He says he is currently in a situation where he cant cope with the pain.

He fatigues easily, even after low exercise rate and has a poor sleep parttern and says he wakes unrefreshed.

He has quite a limited lifestyle. He lives with his mum. He gets up between 0630 and 0900 and then tidied the house if he has the energy and his pain allows. He then goes to get his daily prescription and spends the rest of the day "doing nothing" which usually involves watching television or surfing on the laptop. He goes out very little.

He says he has tried various forms of excercise including swimming in the last couple of weeks but he finds that when he exercises he is much worse for several days afterwards.

I note that you have done bloods and inflammatory markers which have come back reassuringly normal.

He has a previous history of mental health problems and I understand he has a diagnosis of borderline personality disorder for which he saw Dr Hayward in the past but is now discharged from his service.he is on the waiting list for Dialectical behavioural therapy which I understand to be a varient of CBT.

In the past there have concerns around codeine misuse which I understand had been in relation to buying over the counter codeine. He days he has not used any other illicit medication in particular and has never bought street drugs.

In the past he has held down a job initially as a health care care assistant in the stroke unit here, then as an office worker with allied health care organising care rotas. I understand he had to leave paid work because of mental health issues because of mental health issues.

I agree the diagnoses here is Fybromyalgia. Betty Little and I saw him together and spent a considerable amount of time going through the evidence base and also our experience of treating fybromyalgia. He is already on correct therapy with pregabalin, naproxen and paracetemol. It is doubtful that his codeine and nefopam are significantly helping his fybromyalgia. He is also on propranolol for anxiety and omeprazole for mild GORD.

As you know the mainstay treatment in fibromyalgia are anti-neuropathics, which he is on, and then psychological apprroaches such as CBT or other behavioural therapy and graded exercise. We discussed other drugs including tramadol, MST and oxycontin. Duloxetine and amitryptyline. I explained that the evidence does not favour opioids in fybromyalgia and our own clinical experience is very similar.

Marc has been on the fybromyalgia forums and brought various suggestions to the table including accupuncture, which we have found to be 50/50 successful in fibromyalgia and we had a somewhat difficult discussion around the fact that there is no cure for fybromyalgia which he found rather bleak and we were unable to offer any cure or significant medicines change.

He id already a member of live active but doesn't seem to make much use of it, and he is on the waiting list for behavioural therapy which I understand to be aimed at his borderline pErsonality disorder, but which is bound to have some general amelierating effect on quality of life and ability on quality of life and ability to cope with pain if successful.

I am afraid the pain service has anything else to offer this gentleman. However he did ask for a second opinion. I am happy to arrange that and he was content to see one of my colleagues here in Perth.

Kind regards.

J bannister.

I feel his Dr has neglected his duty of care towards me and eould really appreciate feedback. Thanks

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  • Posted

    there is no magic pill hun he cant give you what he hasnt got .

    any painkiller will eventully stop working .and will have to be changed and or up dosed . the higher you start the less you have for manouver 

    to higher does of some pain meds can stop you breathing ,you only have to look at what happened to micheal jackson  thats what killed him over dose of pain meds .

     

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    • Posted

      If I'm being honest I really don't care. I would go with that if it meant relief from the pain (if even temporary) surely you can understand that. And what's his excuse to not offering me accupubture. I wad hoping you guys would be backing me up.

      Regardlesss though Bannister is getting reported to the GMC.

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    • Posted

      i am not backing you up or dismissing you ,we all deal with pain in a differant way , like iv said before iv had it for 10yrs  iv just excepted it . 

      and cope with it in ways that suit me . iv just had a 4 week pain flare where the pain has been 10+ iv made it out of bed to my chair and slept most of the day simply because the pain was so over whelming .and yes in those 4 weeks i could have easly have checked out.

      then i woke up one morning and the pain was about 3 i sat there poking myself hard with my finger going it doesent hurt hardly at all  . iknow it will be back and next time it might be worse . but i;l deal with it then

      .in the mean time iv got the I B S  the anxety, palpatations ,sweats,dizziness depression

      nausea, and a knee that keeps giving out .to deal with .

      theres no right or wrong way just your way . the way that suits you .if the doctor wont help you .then you have to find away . 

      do you get bennifit . i do well till june . god knows what will happen then

      i use my bennifit for my accupunture iv never been offered it for free either the last 4 weeks iv had to have 2 sessions aweek il be able to drop to one again soon  . we are all in the same boat . 

       

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    • Posted

      Well you are clearly stronger than me. Basically I have no future. I am just at the beginning of this journey of hell and its only going to get worse, I cant allow this to happen. I am not built to deal with this level of pain even at tho stage. I admit it I am weak. I am a failure. Seriously what's the bloody point.

      I come on here for support but am offered no light at the end of this very very dark tunnel. All doom and gloom. No hope.

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    • Posted

      Soo feel for you Marc...I don't understand why the dr hadn't tried you on Amitriptilyne yet..(or maybe he has...) it was used as an antidepressant for a long time-rather an old med....they found out that it was stopping the pain at the nerve end, hence stopping it from travelling to the next nerve and stopping the pain In your body...so they now use it as a pain management med, must also help somewhat with the depressed state we easily find ourselves in......( I do believe it can be addictive though for certain people.) I have been on 25 mg every night about 8pm....great sleep, no pain..for 15 years now...if my memory serves me right...I was given a much higher dose originally, but it didn't like feeling like a zombie all day. So I dropped them myself.......dr told me I would probably get detoxing Symtoms-I did.....but it was only for a few days...now I'm right...saying this is easy for me I know..I've had Fibro for over 22 years now..I also have Sorgrens Syndrome, asthma, arthritis all autoimmune issues, plus others..I only say that to say this.....I have learned how to look after me...yes..it did take a few years though..it is just soo important to have strong caring & loving people around you..if you haven't then get some....or drop some who just don't care..you need positive validation...to have what you are suffering from, acknowledged by your piers/family etc...trying to stay positive in a really negative situation is very powerful..the less stress really does greatly help, but it's just too hard when you are soooo stressed..I just want to encourage you Marc..what you are going through is real and yes rotten and yes you were not made for this suffering, but you have it unfortunately..and let me say I testify to this..IT DOES GET BETTER..MUCH BETTER..GOES INTO REMISSION..THEN YOU MAY GET FLARE UPS..I know someone who has had no Symtoms at all for years..and were very very bad once..there is a saying: " if you do the same thing all the time you just get the same results" ..and that was soo true for me...I began to realize to  Expect different results..I had to start doing things differently...and that I did..and now I am sooo much stronger than ever before..you can certainly do this too...yes it may be hard,,but when you come through the other side of your horrific experiences-( and you will, we all do)  it will make you soo much stronger and you will be enabled to help others who need support and encouragement like you do right now...it's like play it forward.....through your experiences...you will be sooo strong..you will look back in total amazement at just how you achieved what you have...I am a Christian, so I have a lot of positive supporting people in my life especially from church...I have a very strong faith and that has undergirded all my issues over the years...I gotta say, I just don't know how anyone handles all their struggles without the knowledge go Christ..I really hope and pray things will turn around for you really soon, but please don't loose heart...it could be just around the corner......remember YOU ARE NOT EVER ALONE, THERE IS ALWAYS SONEONE WHO FEEKS YOUR PAIN AND LOVES YOU UNCONDITIONALY...be blessed Marc.....:-) xxx looking forward to hearing from you again soon..
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  • Posted

    Marc I'm not a doctor but I do suffer from fibro. It seems that your mood is playing off your pain and vice-versa. I don't have any answers except to say that Boots Calcium, magnesium and vitamin D tablets do help me with the pain and valerian root helps me get some restful sleep. Best Wishes.
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  • Posted

    Marc..I totally agree with Bluesman.....vutamin d3 and magnesium...double the recommended dose..really great..:-) do hope your feeling a bit better.....really feeling fir you...don't let your pain rule who you are..:-) xxx
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  • Posted

    Unfortunately Marc the doctor is right, I've had Accupuncter and it only worked for twenty four hours after treatment. I worked for the pain clinic, he is correct that there is little they can offer you, it's hard to accept but true. You would be better seeing a Rheumatoligist who can give more constructive treatment. I'm afraid reporting this doctor will only end in disappointment for you and could lead to future problems with your treatment in that health professionals could be wary of treating you in case you report them. Please think very carefully before reporting him. 

    Take care

    Shelagh

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    • Posted

      Well 24 hours is better than nothing isn't it?

      Also you may have worked for the pain clinic but you know nothing of my personal situation and severity of fibro on me. Different meds work differently on different people so you cant possibly say that their is little they can do for me. How do you know things wont work for me if they haven't been tried yet.

      Also I asked my Dr about rheumatologist and he says there are none in my area.

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    • Posted

      i agree about reporting them ,i did this due to my son being ignored for months while his weight plummeted all it did was make other professionals weary of treating him and they were very agrasive with there manner.
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