pain specialist vs. neurologist

[smfrg]

how do i know which one my husband needs to go to. basically what is the difference. i posted yesterday that my husband was told he has a herniated disc (below his injury level) and the spine surgeon wants to do surgery. but he isn't even sure that is why my husband is in so much pain. i would like for him to see a neurologist i think, but i'm not sure that is the correct place for him to be going. i've been doing a lot of research on this site and now i'm leaning towards a pain specialist. does anybody have any clarification for me?

thanks in advance
steph

[firesmurf]

so sorry about your hubby steph.i know it can't be easy watching him suffer and you being his wife and caregiver,well you gotta make sure to also take care of yourself too.i hope you are.

honestly,for his level of issues,a neurologist would really not be the way to go.most neurologists i have had to see for various problems thru out my life and since my injury,if it is more than headaches,they really just don't have that level of knowledge to really be a good source of info for your hubby.even some of the neurosurgeons i have had to see just don;t seem to fully 'get it' when it comes to the really insane crap that comes along for the ride with SCI.finding a good experienced,knowledgable(on SCI)neurosurgeon just for that consult would be a great idea.going to a good pain management doc would also be a wonderful idea.they just have so many modalities to manage pain availiable than any other type of specialist can possibly offer.they can also do things like discograms or myelograms that can specifically find the 'bad' area that is causeing pain.they try and reproduce it during this test in order to find that needle in the haystack.

the majority of PM docs are also anesthesiologists so they can do some pretty amazing things as far as nerve blocks and other injections that other docs just don't do.i love my PM.without his experience and overall knowledge of pain and treatments,i would not be sitting here even able to type this right now.my pain was not being properly managed prior to starting up with my current PM(it will be four years in feb that i started with him).this is what i think your hubby could really benefit from the most,just a good PM doc.

he needs experience and knowledge of the best PM modalities,and that would be with a good PM doc.but seeing a neurosurgeon who does have experience dealing with SCI(you can ask when making an appt)would really also benefit him greatly.our bodies are just not normal anymore so it takes someone who understands 'us',or the new us,to really come up with the best possible treatment plans and options for pain control too.this is what i would do in your posistion steph,really.he needs experienced and knowledgable people in charge of his healthcare,i do think these would be that best bet for him.i do wish both of you lots of luck with this and hope you can find the best possible PM to help you.please keep me posted on how things go,K?

just don't forget to take some time,even a little bit,each day for yourself.you need to be able to just shut out things and recharge your own batteries everyday.i have been on both sides of being the caregiver to my son when he has gone thru some hellish times and also on the patient side.you just need to be sure to take some time for you,or you wont be any good for yourself or anyone else ya know?take care steph and please let us know how things are going,K?Marcia

[Eileen]

I agree with firesmurf that a neurologist probably wouldn't be that helpful. I think pain management specialists are much better at taking a holistic approach, thinking of the entire body instead of just a specific nerve. In my experience neurologists are too eager to cut, too eager to second opinion the surgeon who does want to cut, with no real thoughts to post-surgical impact of the surgery itself. A pain specialist usually does not even think in a surgical context, and I think that is far better at times.

[razzle51]

Once you are diax a Neurologist is useless . Dont see one .

[metronycguy]

in this case a nueroligist may be good idea to see, if the pain is from a herniated dish below the leve of injury, hopefully the neurologist can do some kind of conclusive testing.
it may not be worthwhile to do surgery on a herniated disc in this case , or it may be extremely worthwhile.
if the pain was really intense and was going to force one to take a lifelong bunch of meds that all are going to have harmful effects eventually removal of the offending herniation may be worthwhile.
it is th same as with AB and back surgery, depending on age possible complications, what can be gained, level of pain= is surgery a viable option.
herniated disc could also cause ad, especially at night .

[David Berg]

Quite honestly, I think you really can't generalize here. It depends on the individual doctor much more than what their speciality is. Besides, there are neurologists who call themselves pain specialists. Pain specialist isn't a specific specialty that I'm aware of, what's their actual area of training?

[smfrg]

thanks for all the input. it's still so up in the air. i think we will hold off on surgery (they wanted to do it the week after thanksgiving) and first off will go and see the pain specialist his sci doc recommended. if that doesn't pan out we might try the neurologist. i am just scared for him to have another surgery. even the surgeon who did the mri said it should be a last resort. he's taking quite a bit of meds right now. to list them all...gabapentin, lorcet sp?, xanax, soma, baclofen, ditropan, just stopped naproxen (wasn't doing anything), cymbalta, then his vitamins and stool softeners. the funny thing is he's had a bad day today. been in bed all day. he took some lorcet and soma earlier and it didn't do a whole lot. about 45 minutes ago he took some more and a xanax. his spasms are gone and of course he's a bit out of it from the meds, but the pain is not as bad at the moment. thank you all for your advice, i keep reading it over and over and am going to try to do the right thing for him.

[metronycguy]

main thing is to make sure this disc is causing the pain, you dont want him to go through the surgery and still have the pain

[darkeyed_daisy]

For me the Neurologist was worthless....but an excellent pain management doctor gave me my life back.

[firesmurf]

see an actual neuroSURGEON and skip the ologist all together,really.neurologists just really dont 'do' anything for you like an actual neurosurgeon could.like i mentioned before,if you have more than just a headache type process going on,well,they really are not much help in trying to pinpoint a structural or disc issue,you would be better off putting your energies into a pain management doc and a neurosurgeon.not all neurosurgeons just want to cut people.they can offer you some possible options and ways to actually diagnose spinal issues and better define them,a neurologist just really cannot offer you what an actual neurosurgeon can.obtaining an opinion from a NS would be much better and coming from alot more actual 'hands on' knowledge than a neurologist.like dave stated above,what it all really comes down to here is who has the best possible overall experience with your particular issues.thats who you want to be seeing.but i really would seek out the PM first and then go from there.

it really does sound like your hubby may be undermedicated with what he is currently taking for his pain.being on short acting meds to try and treat chronic pain,espescially when it is really severe,just keeps people doing the up and down thing all day long with having to dose over and over again everytime the meds wer off,you know what i mean?using a long acting narcotic like oxycontin or MS contin or one of the other long acting meds just makes such a huge difference in maintaining a more stable type of coverage without that yo yo effect going on with his pain.this is what most PMs usually recommend as well.long acting narcotics.these really made a big difference in my overall pain coverage.just a suggestion for you.just getting him the help he needs from that pain management doc will really help him in many ways to become more in control over at least some of his pain.but personally,i would skip the neurologist since your hubbys situation and his needs really kind of go beyond the neurologists areas of experience,with most anyway.unless you can find one in a million who really does specialize in SCI really heavily,it would really be a waste of time i think.i hope things go well and you can find the answers and the help you need for him.please let us know how things are going.Marcia

[betheny]

I just started w. pain management. My problems aren't solved but I'm very impressed w/ the dr. and his knowledge.

[sandim]

If he has a herniated disc, then by all means, see either on orthopedic spine surgeon, or a spinal neurosurgeon. You don't want to see a regular neurosurgeon and you don't want to see an orthopedic surgeon who doesn't specialize in the spine. Whichever type of doctor you choose, make sure that they are board certified in spinal surgery. They should make sure that the disc is the cause of the pain he's having now. It could also be an impingement of the nerve roots by the herniation that is causing his pain, so it is really important to determine as much as possible what is causing his pain before his having surgery.
Good luck to you both,
Sandi M

[mike]

I have had mixed experiences with neurologist vs pain specialist. I have found that generally neurologists are more ready jump into surgery as opposed to pharmaceutical methods for dealing with pain. Sometimes surgery is the right answer but I would certainly get a second opinion before having that type of surgery. I am fortunate now having a neurologist who specializes in pain management.

[cheesecake]

Many excellent pain management doctors are in fact neurologists with a second speciality. I think it has less to do with the speciality area and much more to do with the Doctor as a person. My pain management doctor is an anestheologist and probably one of the most caring, patient physicians I have ever seen.

[sandim]

I agree with you Mike. A second and even a third opinion is always a good decision. At least then, if they agree and many times they do not, you have a good direction to go to. Most board certified neurosurgeons and orthopedic surgeons won't recommend surgery unless the herniation is really big, impinging on the nerves or causing a neurological compromise.
Although there are studies out there that say that most herniated discs heal themselves in two years or so, there is also PT, ESI's ( careful with those), back school and a few other options to persue along with pain management if you decide that surgery is not something you want to consider at the moment.
Sandi

[metronycguy]

i think the main difference in most of our cases is can the pain be stopped by surgical intervention or even modification of posture. if something is pressing on the nerves, even with good pain management, the trouble spot may cause a lot more serious things like AD or other problems with bowel and bladder, plus left untreated and for someone that spends most of their life sitting, that alone is going to irritate the problem,
i look at it like if a screw came lose in your hardware, and that is where the pain is pointing to. would you just treat the symptoms, or go in there and fix the loose screw that is causing the problem. one of the young strong guys that used to post here got some bad AD from a herniated disc below his level of injury

[smfrg]

well my husband went and saw the pain specialist last week that his sci doc recommended. he said he needed to get with his doc at TIRR before he could decide what needed to be done and he would call him in a week or two. well my husband is in a lot of pain right now. so much so he is talking about being better off not here. so i told him to call the doc and see if he found anything out. they told him they couldn't help him. he needed to go and see his sci doc and figure out what to do. that's great. the sci doc refers him to the pain specialist and the pain specialist refers him back. i don't know what to do. he is angry and in pain. stuck in bed. i am now on the verge of a nervous breakdown because i don't know what else to do to help him. does anybody have any other suggestions. i'm literally begging now. i email his sci doc begging for help so we will see what happens with that. honestly, could a herniated disc below the level of injury make him hurt so bad?

[metronycguy]

not sure what is going on , but 2 weeks is a very long time for a pain patient.
call the doc that referred him there and find out what is going on. they should offer to manage the painuntil their conference is made

[Lee555]

well my husband went and saw the pain specialist last week that his sci doc recommended. he said he needed to get with his doc at TIRR before he could decide what needed to be done and he would call him in a week or two. well my husband is in a lot of pain right now. so much so he is talking about being better off not here. so i told him to call the doc and see if he found anything out. they told him they couldn't help him. he needed to go and see his sci doc and figure out what to do. that's great. the sci doc refers him to the pain specialist and the pain specialist refers him back. i don't know what to do. he is angry and in pain. stuck in bed. i am now on the verge of a nervous breakdown because i don't know what else to do to help him. does anybody have any other suggestions. i'm literally begging now. i email his sci doc begging for help so we will see what happens with that. honestly, could a herniated disc below the level of injury make him hurt so bad?

Yes, a herniated disc can hurt that bad. A work related freind in another part of the State of Il talked with me last year, 2006, about her disc problem, herniated as well. She had painkillers but they weren't cutting the pain. She called her doctor and told her she had one trip left in her because she wasn't able to get out of bed. The doc said come to office, she said, will you be able to stop the pain? No, but we'll take a look at you. No good, she says, got to stop the pain. So the doctor said, call 911, I'll call the hospital and have you admitted for pain management to get it under control. So that's what happened, ambulance came, sloshed around on her waterbed getting her onto a stretcher, and took her in. Three days she was in there before they got the pain down to where she could eat and function. I think she was in there for a few more before they felt she'd gotten over the hump. So you might actually try that. If your husband is talking about doing himself in, it's got to be really more than he can stand.

[firesmurf]

I have to say i am a bit shocked at the PMs 'no help' additude,just what the hell is he there for anyways??i think trying another PM who actually wants to help your hubby lower his pain may be the next step here.thats just a really nasty additude that PM has.my pm took my hand at my initial eval and told me'we are going to try and get that pain tolerable for you'.i just sat and cried.i got a caring PM doc who WANTED to try and help me.i am just a bit confused on this PMs additude.this IS his job afterall ya know?not all PMs are created equal,believe me.some just try and teach you to "live with it' while others really DO try and help doing everything possible to try and get that pain down to at least 'tolerable'.i think he got a bad one.

like lee mentioned above,if your hubby is truely at what appears to be his 'breaking point' i would certainly have a chat with his main treating doc at this point about getting him admitted just to get his pain managed properly.hydrocodone is just NOT adaquate for his level of pain.unfortunetly,becasue of just what can become involved with any level of herniation,it CAN be 'that bad' at times,really.if he is just suffering that badly,he needs intervention with proper pain management til they can come up with the right combo of meds to keep things at the bare minimun til a decision gets made about the disc and surgery.by all means,let his main doc know just where he is at in his head with this pain.i think he would want him admitted just to get the pain down at this point.he just needs someone to give a damn about his suffering.you are his main advocate right now,and honestly,its time to just start demanding help here for him.he should NOT have to suffer like he is and has been when there are steps that can be taken to get things made more tolerable.

the one big thing i learned when my son was going thru hell before mine came along is that at times,i HAD TO step in and demand that certain things just be done for him.start kicking some ass and taking names,you know what i mean?as long as i knew that i was right,it did not matter whos toes i stepped on anymore,i did what i had to do to get my sons needs met.the simple fact that your hubby IS truely suffering here to the point of saying i don't want to be here anymore,well his docs NEED to know just how excruciating and intolerable things are for him at this point and step up and just DO thier jobs for him as his docs.your hubby is in a crisis right now and just needs at least one of his docs to listen and help him.i would be beyond furious right now having to watch and see just how badly your hubby is suffering and no one is taking control here.i am sure you are.use that to your advantage and like i said,start kicking some ass and waking these docs up to your hubbys needs.i really am so sorry that you two are having to go thru all of this just to get his pain managable right now.that just sucks and its just not right either.if nothing else,show up at the ER and demand some help.hopefully you can get at least one of his docs to listen and help out by just doing his freaking job.good luck steph.please keep us posted.hang in there hon,Marcia

[mike]

well my husband went and saw the pain specialist last week that his sci doc recommended. he said he needed to get with his doc at TIRR before he could decide what needed to be done and he would call him in a week or two. well my husband is in a lot of pain right now. so much so he is talking about being better off not here. so i told him to call the doc and see if he found anything out. they told him they couldn't help him. he needed to go and see his sci doc and figure out what to do. that's great. the sci doc refers him to the pain specialist and the pain specialist refers him back. i don't know what to do. he is angry and in pain. stuck in bed. i am now on the verge of a nervous breakdown because i don't know what else to do to help him. does anybody have any other suggestions. i'm literally begging now. i email his sci doc begging for help so we will see what happens with that. honestly, could a herniated disc below the level of injury make him hurt so bad?

Sometimes I have found that when you get a run around from your doctors it is better to find a center that is expert in your condition. You live in Texas, so I am sure that you can find a medical center that has SCI as a specialty. Moving from one doctor is very frustrating and can actualy be dangerous when a condition needs to be promptly treated. Nationally I have found that Craig Hospital in Denver is the best around. If you cannot find anything you are satisfied with in Texas you might try them.