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Mental Health

I Think That I Blew my First Psychiatry Visit

03/18/2008

Question:

I have had chronic low back pain for years and have had extensive medical work-ups and followed the various treatment suggestions. This isn`t a chronic pain question; it`s more or a mental health issue. I have moderate low back pain from a spinal fusion from an old infection from an epidural (which was supposed to help the pain, but obviously did not).....I went to a "pain clinic" briefly, but I was more interested in having them coordinate my physical therapy, but they wanted to have me take anti-convulsants (neurontin etc)and get more injections, so I stopped going. My medical doc pretty much threw in the towel as far as further treatment (I don`t blame her)...so I treated myself with various self-help books, lost about 100 lbs and the pain became almost manageable; except at night...I used a friend`s rx to help increase my pain threshold as well as get some sleep at night, until the rx finally ran out. I have become very depressed over the return of the pain, so i self-refered to a psychiatrist as a last resort...my primary-care doc doesn`t want to hear about chronic low back pain and just says go to a pain clinic; so I obviously don`t see my primary care doc anymore. I finally saw the psychiatrist adn thought that she was very empathetic about the depression (it`s really bad)...that is until I mentioned that I was self-medicating for the pain and insomnia and i hinted that I would appreciate her writing me another RX. She pretty much went ballistic and told me that I was "drug-seeking" (even though we never got around to discussing what drug I was taking) and wasting her time......and that if I stopped abusing someone else`s rx that my depression would probably resolve. I never got a chance to discuss what I was taking and why; so I basically got shown the door and told not to return. Did I make a big mistake by admitting that I was "treating myself"??? I guess that this was insulting to her professionally and I wish that I had not mentioned it, but the depression/insomnia is so bad that I just blurted out the truth, hoping for help......My question is: I found that I can get the drug on the internet cheaply (about $50/100 25 mg tablets, and I take 1 at bedtime and it really helps with the pain, I then get some sleep and the terrible depression seems to lift a little(*the drug is generic elavil)....I would like to try to see another psychiatrist, but now I feel really bad being labeled a "drug seeker".........this pain/insomnnia/depression hurts way too much ......should I start over with a new doctor and omit my drug-seeking past? thanks.........now I feel really ashamed

Answer:

Thank you for the question.

Issues with chronic pain are complicated, as your course certainly attests.

Even physicians require seeing other physicians for treatment. Attempting to "treat" one's self can be perilous.

Similarly, most physicians are leery of patients who self-medicate. Ultimately, a patient seeks an evaluation from a physician who then exercises some clinical judgment based on education, training, and experience. A patient's opinion or question is perfectly fine (e.g, "Would drug X be suitable?"). Having a specific requirement is another matter (e.g., "I must be on drug Y that you must prescribe to me.").

It would have been worse and potentially detrimental to your health if you had not disclosed your history with Elavil. I see no harm in seeking another psychiatrist and stating upfront that you have found Elavil helpful, and would this physician feel comfortable prescribing the same. Similarly, are there any measures that you could take to help demonstrate that you are reliable and "above board" with the prescriptions (e.g., limited supplies of meds or refills, not "running out" early, attending appointments regularly, etc)? Would your new primary care physician feel comfortable prescribing the same?

Best of luck.

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Response by:

Ram Chandran  Kalyanam, MD Ram Chandran Kalyanam, MD
Clinical Assistant Professor of Psychiatry
College of Medicine
The Ohio State University