treatment of chronic yet somewhat infrequent pain?

[kittens822]

Sorry for the strange title just not sure how to word it. I have been a chronic kidney stone former with varying frequency for the last 15 years and I'm 33 years old. For a roughly year and a half period I was passing multiple stones a week and I'm pain more days than not. My urologist referred me to a pm Dr who I saw for 11 mos. I had my last lithotripsy in August and have been doing a lot better since. I haven't see pm Dr since July bc that was my last appt before my procedure. I was much better until probably mid October and even then only had 4 stones so my urologist have me 2 prescriptions between then and dec when I passed the last stone. I thought going to the pm for 4 stones that I expected to pass easily was overkill. then I had a pain free January and most of Feb. Been in sporadic yet severe pain the last 4 weeks with stones, haven't gone back to the urologist because I don't want yet another xray, had to go to the er in December with the last stone and that Dr was very concerned with all cts/xrays I've had. So I've just been playing it by ear hoping it'll pass soon and imaging won't be necessary, but it's really hard sometimes. Also I'm not in pain everyday. I know my urologist doesn't want to prescribe meds on any kind of regular basis because that's why he referred me to pain doc in the first place. I was thinking of going back to pm Dr and asking if he'd be willing to see me every other month and adjust my pain pill count down since I won't need them as much. Does this sound reasonable? Do you think he would be willing to see me again since I just stopped going? I notified the office of that last procedure and canceled my August appointment because told them I didn't need it. Is anyone else in a similar situation and if so how do you manage your pain? Ideally I'd like to have something on hand for when attacks occur without having to get an xray every single time. The er is only an option during evenings and weekends bc I'm home alone with 2 toddlers and no transportation weekdays. Its just been really hard managing the pain in my own this past month. Any advice?

[Tuckamore]

Just checking in to see how you are doing. I've been off the boards for awhile due to a nasty personal illness.

I'll look forward to hearing more from you. I hope you'll reach you goals soon. When kidney stones are painful and chronic it had been devastating to our functioning and personal life. My heart goes out to you.

Take Care,
~Tuck

[kittens822]

Thank you for your reply! I contacted my urologist this morning and requested a kub which I'll have done tomorrow morning. Once I get the results I think I'm going to contact my pm doctor and see if he'll accomadate me. Hopefully that way I can cut back on all the xrays and catscans. I'm weary of the er only because the last er Dr refused to order any imaging because of how many I've already had. Unfortunately I don't always have blood in my urine with stones so a lot of the time they'll tell me I don't have one because of the lack of blood. I've really had to assert myself to get imaging in the past but I'm afraid that will be an uphill battle now. And of course I'd like to avoid extra radiation whenever possible. I really feel for those who are in constant pain, I can't even imagine if this were a 24/7 issue. Again thank you so much!

[Tuckamore]

Hello Kitten822,

Please excuse my tardy reply. I am sorry to hear about the situation you are experiencing - I've been there.  I too manufactured multiple kidney stones. The pain can be brutal.

To answer your question: I think it would be appropriate to contact your PMP and discuss your proposition with him. It certainly makes sense to me that your pain requires periodic control and not constant opiates. It's pretty sad that a Urologist cannot RX an opiate for you more regularly - but that's the state of our Opiate Phobic country.

In your instance, ER is an appropriate choice for you when you are passing a stone. Obviously a CT will reveal that you do have stone(s) and that you have a need for pain management. I hope you don't suffer needlessly.

Your Urologist should work with your local ED (emergency department) which will allow them to treat you as needed (PRN). If you return to the same ED they will be familiar with your situation and have previous CTs to review - and can repeat a CT. This should alleviate any fears that may have of drug seeking behavior. It would allow your pain to be treated PRN.

I hope something I have offered has been helpful. Please let us know how you are doing. I wish you all the best.

Take Care,
~Tuck