Everything that patsgeadogs said was right on the money, & I don't think i've ever heard (or read) it explained so clearly, & accurately before. If you aren't go to advocate for yourself, no on else will be doing it either. If you go in & your honest, & forthright, it makes a big difference as to how your treated. Good Luck
First, I would relax. Luckily for you you are much younger than I am and won't have to fight to get good pain relief. (Mine pain issues started at about your age and that was some 30 plus years ago, talk about fighting to get pain meds!).
I would imagine being the in area you live in you would certainly have a good choice of doctors. My suggestion would be this. Either get your original records, or a copy of your records. Doctors find it very hard to argue with the cold hard facts of x-rays, tests, etc. particularly when it comes to pain because it is so subjective. Be anything but scared! Meet the doctor like he is what he is, someone your are interviewing for a job - the job to treat you properly! Confidence in what you are doing and that you deserve to have as pain free life as possible and enjoy your life just like anyone else goes a long way. Make sure you are comfortable with the doctor. He is for hire, and like any other job, there are others out there. (Okay enough of my doctor rant - but true!) I've been where you are. You shouldn't have to fight for relief, you deserve relief. Most primary care doctors are not used to treating long term pain and are not terribly comfortable with doing so. They are also not "up to date" on the latest advancements in Pain Management. So you are doing the absolute right thing.
If it were me, (and some of these things seem almost stupidly simple), I would walk in, greet the doctor with a firm hand shake, looking him directly in the eyes. Hand him your records and explain your situation without emotion, but just say that you feel your current doctor (if you wish to bring him/her up) does not quite understand your pain issues, the amount of pain you are in and that your are not getting sufficient relief, that you are looking long term and want to find a doctor who will be able to treat your pain sufficiently, and is up to date on the latest medications. (i.e., now you're making the new doc the hero, a little ego stroking goes a long way). I do not mean this to be any type of manipulation, just putting yourself on an even playing field with your doctor helps him respect you.
Let him look over your records, answer his questions honestly. If the Ultram is not helping your pain say so. There is a good chance he will want to try you on one of the longer acting pain meds as colleen1212 has mentioned, adding something "tylenol" free that's shorter acting for break through pain. If you have taken something in the past that has helped or not helped, list those medications for him/her. You have a legitimate reason for needing pain medication and you absolutely should not feel like you're doing anything wrong, and definitely don't come across like you are. Asking a doctor to help relieve your pain, so you can live as normal a life as possible is the attitude you want to project.
Finally, one last thing. It may take a while to find the right balance of medications for you. Don't get discouraged, but don't hesitate to explain to the doctor what does or doesn't work, and the reasons. This will help him/her to prescribe other meds that might work better for you. I wish you all the best and please don't be nervous. Most good Pain Management doctors are very familiar with chronic pain, and under-treatment of pain. On final thing, if this post sounds a little strident - it's just from my past experience. Try getting pain meds on a regular basis for "major" and proven pain issues back in the 70's and 80s!
Be your own best Advocate. Speak to the doctor as an equal. Explain you are looking down the road and want the most effective but least harmful treatment (to your body a/k/a tylenol, aspirin additives, etc.) that there is. Most any good doctor will respect and respond to that attitude. Calm down and have a good day at the doctor's office! Best, patsgeadogs
When you go in for your 1st appt. They will want a list of all medications that you are on now, and have been on in the past. They will ask what has worked and what has not. They will want your medical history, and they will contact your Dr. that you have been seeing. After a full eval. they will go over your options with you. Yes, there long lasting pain medications, such as the fentanyl patch,they also have controlled-release OxyContin that you would take every 12hrs. they also have one for immediate-release for breakthrough pain. Being a nurse I have seen pt's. on both the time-released for long term pain controll and on the fast-release for breakthrough pain.
Hope this helps