How to find a responsive doctor for chronic pain

43 posts in this topic

My wife and I moved to Germany this February. My wife has been having chronic back pain for a few years now. She also has a shoulder pain that has worsened in the last few months. Over time, many doctors have given us various diagnoses with the most recent being probable fibromyalgia. For the last few weeks her pain has worsened and we finally managed to get an appointment with an orthopedic. So we went to see the doctor on Friday and when she tells him she has two painful problems - the back and the shoulder, he bluntly tells us that today he will look at one problem area!!! Her shoulder has been hurting as much as her back with the pain radiating all the way to her wrist but well he does not want to hear about it at all.

 

He has recommended acupuncture and a therapy/fitness regimen to be taken up after talking to TK and opting for one of their recommended centers.

 

Is this how it works here? She has already been through multiple rounds of physical therapy, cortisone shots, chiropractic sessions etc. but he seemed to be in such a hurry he just took a few minutes looking at an old MRI and some reports, told us it is a muscoloskeletal disorder and gave us the above recommendation. He did not spend any time asking her about her pain or trying to understand her situation. My wife also has thyroid problems and insulin resistance. The doctor did not spend any time understanding these or asked any follow up questions. We have been to hospitals in the US, Singapore and our country India but this is the first time we are coming across an experience such as this at a clinic. It was as if he was going through an assembly line of patients and just couldn't wait to finish one and get on with the next.

 

This experience has left my wife devastated, she is in a lot of pain and sleepless nights due to the pain have added to her woes. She came out of the clinic almost bursting out in tears, we were very hopeful that a first world country like Germany would have better options that would finally help diagnose her problem and treat it suitably and humanely.

 

Anyone have any ideas about how to work with the German healthcare system to find a good doctor for this situation? We were using the search provided by KVWL. An important thing is to find a doctor who speaks and understands English. The problems are complicated enough that basic English knowledge on the part of the doctor is not enough. Any advice at all on how to handle the existing doctor would also be very helpful. We are in Bochum, NRW.

6

Share this post


Link to post
Share on other sites

I am sorry that your wife is having such a difficult time.

 

The system here is not as friendly and most doctors are looking to do the minimum, actually waiting for your body to heal itself (or maybe some don't give a shit and think pain is natural and a part of life).

 

I was in the hospital 11 days on what they call Critical Pain level. I did try physical therapy with minimum pain meds and ended up worse, having to get demerol shots every 5-6 hours. After the MRI showed that I had a slipped disc (actually, have 3 (2 in my neck) that was pinching a nerve, the doctor opted to do an x-ray guided injection. I do not suggest this, if you are awake....!!! This took 11 days. I still can't stand or sit too long.

 

I am now in physical therapy, acupuncture and seeing a neurologist (which is difficult, but we have my husband's parents' doctor, which helps). Also, I have started juicing a lot more, heating pad, sauna (great for relaxing), yoga, taking natural muscle relaxers and echinacea (heard that it helps if you have a bacterial infection....they stated antibiotics, but I try natural first ( http://www.guardian.co.uk/society/2013/may/12/back-pain-ask-doctor-antibiotics?INTCMP=SRCH)). The neurologist is probably the best for your wife, as they are up to date and understand the pain. It took us months for the referral and the neurologist office has a wait of 8 weeks.

 

It sounds to me that your wife has a similar problem, because when pain radiates it is nerve related. Plus, the back, neck, shoulder, TMJ, arm are all connected. It could be any area that is worsening the problem. Plus, keeping the thyroid in check is very important, when it comes to pain.

 

Dealing with different personalities is part of the experience, but my husband speaks the language and doesn't back down. My husband had the hospital doctor call the orthopedist that we were referred to, after the orthopedist tried to change the instructions. Which, pissed this orthopedist off enough to confront my husband, to which my husband stated that he was only looking out for his wife.

 

I know this doesn't help much. The best advice is to state what you what, expect and need. Good luck and I hope that your wife gets relief soon.

4

Share this post


Link to post
Share on other sites

First of all, I am really sorry for your wife's situation and can empathise somewhat.

 

As a chronic back pain sufferer and having lived in a few countries, it is my experience that germany does lag well behind other places in terms of both its attitude towards chronic pain and treatment strategies (about 10-15 years behind). I saw a gazillion physiotherapists/orthopaedic doctors in my time there; some of them were very abrupt to the point of being rude (one of them looked at my back for 10 seconds, wrote a prescription for rehasport and then said "Wir sind fertig" and sent me out the room before I'd had the chance to tell him anything of my medical history or even where my pain was).

 

In the end I was able to keep my pain at a manageable level by going for various types of massage every 1-2 weeks (e.g. sports, thai, trigger point), and only using therapists that I felt comfortable with. I had to pay a lot of this from my own money because they were either private physios or commercial massage therapists, but it was worth it for my sanity. However I never resolved the problem and ended up moving countries to fix it (well there were lots of other reasons I hated germany, but the back pain was certainly a contributing factor).

 

One thing I am doing now which I find very helpful is bikram yoga (the one where the room is heated to 40 degrees). For some reason, bikram yoga isn't expanding very rapidly in germany, so there isn't an official brand-name bikram school in your area, but there is an almost-equivalent "hot yoga" school in cologne, which might be worth checking out: http://www.yoga39.de/. I haven't been but I emailed them a bit when I was still in germany and they were very friendly. I believe some of their classes may be taught in english.

 

good luck...

MT

4

Share this post


Link to post
Share on other sites

I'm sorry to hear about your wife's pain. Finding a doctor who listens is hard work. I've been through this as I've been in pain for more than a year and I am German, so for you looking for an English-speaking doctor who listens is even more difficult.

Here's what I found out:

-Call your insurance and ask about a doctor. Tell them about your experience and ask for help. Since they are the ones who will pay for any redundant therapy, they're likely to listen. They also know about doctors in your area.

-Talk to neighbours, friends, ask them about recommendations. Be warned, though, if you ask elderly Germans, this may take a long time.

-Thai massage helped me a lot.I described exactly where the pain was and was given a deep massage which really helped. It took a few sessions and I had to pay privately, but it was worth it.

-There is a German section of the International Association for the Study of Pain,

http://www.dgss.org/die-gesellschaft/. If you have a German speaking friend look at it, you may get some more information.

Good luck.

2

Share this post


Link to post
Share on other sites

I, too, am terribly sorry to hear about your wife. I have suffered with similar issues over the years. However, I've been very lucky with good doctors here who listen.

 

I'm not a doctor but her problem sounds like cervical discs to me. I had a successful operation on one my 20's and was told that it should be good for 10 years. Almost 30 years later and still kicking. I currently have 3 herniated discs in my neck and, at times, similar symptoms as your wife - neck/back, shoulder and arm pain. My Hausarzt sent me for an MRI some years ago to get it diagnosed. I have managed the pain by never carrying anything close to heavy on one arm. I use a shopping trolley and only carry small, light purses.

 

My lower back flared up a few years ago and I got immediate help. First tried all the physical therapy,etc. and then another successful surgery. (On a public holiday during a doctor strike)

 

When I have a problem, I only use a neuro person. I would never let an orthopod treat my spine. That is just me but it has worked out well. I could make a recommendation if you lived in Munich. My husband had a bad back problem a couple of years ago and my neurosurgeon gave him the guided injections along with a PT regime and he was able to avoid surgery up until now.

 

BTW, we have public insurance and all was paid except a small portion of our PT.

 

I also think that yoga is excellent if she can do it.

 

Please change doctors. There are good ones out there. Hopefully, someone here can make a recommendation.

5

Share this post


Link to post
Share on other sites

I am sorry to hear about your wife's pain,and I can appreciate the fact that it is even more frustrating when your doctor is not interested in what you have to say.

 

It may be worth your while to look at alternative treatment options. Consulting a chiropractor and/or an osteopath may be beneficial as far as pain management is concerned. The added benefit of alternative medicine is that it is patient centered and you will more than likely get a better response to your concerns.

1

Share this post


Link to post
Share on other sites

There are good doctors and bad doctors and a whole bunch of doctors that land somewhere between those two things. You might find it useful to read through this recent thread: Is it me or do German doctors not care? - Cultural differences with medical culture

 

I really hope her diagnosis turns out to be something other than fibro because from what I've heard about that from friends who suffer from it, it can be horrendous. But, if it is, then at least a confirmed diagnosis will improve chances of getting appropriate treatment (which there isn't a lot of, unfortunately).

 

It sounds like you should look for a new doctor. And maybe this time you can send in her records before the appointment and make sure they know that you're not coming for treatment for a new problem and will need more than five minutes.

2

Share this post


Link to post
Share on other sites

Sorry to hear that. Sounds like you would need what can be found by searching for

"Fachklinik für Schmerztherapie", preferably near Bochum.

 

Maybe your problem is that your choices are narrowed down by the need to find an English-speaking doctor. It would be more important to find a doctor who specializes in pain management/therapy, and it is usually recommended to take an interpreter with you. If a doctor is able to communicate basic things in English it will still be exhausting to do so, and I guess that's why "normal" doctors prefer not to do it, a) because it takes extra time they don't get paid for and b.) they might be afraid to miss something or not inform you properly. If you don't speak the language it's your responsibilty to take an interpreter with you. It makes things more complicated, but your chances to get the treatment you need are better if your choices aren't restricted.

6

Share this post


Link to post
Share on other sites

If the problem was explained in writing (e.g. a short letter, perhaps translated into German) and given to the doctor, they might have less of an excuse to ignore things.

 

 

Volkskrankeit Schmerz

Zehn Praxen suche ein Migräne- oder Rückenschmerzkranker im Schnitt auf, bevor er an die richtige gerate, berichtet Michael Zenz, Leiter der Schmerzklinik an der Uni Bochum und einer der frühen Visionäre seines Fachs.

[According to Michael Zenz, head of the Pain Clinic at the University of Bochum* and one of the early visionaries in his field, the average patient with migraine or back pain visits 10 doctors before finding the right one.]

 

* Abt. f. Schmerztherapie

Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil

Bürkle-de-la-Camp-Platz 1

44789 Bochum

Tel. 0234/302-6366

(source referring to a Prof. Dr. Christoph Maier leading a research team on pain therapy; includes a link to an association which aims to improve pain therapy in the healthcare sector: Gesellschaft für Qualifizierte Schmerztherapie - Certkom e.V., which includes info on certified pain clinics and certified pain laboratories (includes Bochum))

3

Share this post


Link to post
Share on other sites

 

It was as if he was going through an assembly line of patients and just couldn't wait to finish one and get on with the next.

 

Something about the economic conditions under which doctors with their own consultancy operate within the public health system: Each group of specialists is allocated an overall budget by the public health insurance. The doctors bill the Krankenkassen based on a system of adjustable points, i.e. if the cost of their services exceeds the overall budget, those points will be worth less money. This system means that there is a fixed basic rate for each patient of a consultancy per quarter year, and these fixed rates are so incredibly low that more complicated cases who happen to show up at the end of a quarter year when the budget is already exhausted are actually treated without remuneration. See this piece of info from the German association of orthopedics. For example, the average rate for one patient per quarter was 22 € for orthopedics in the North Rhine area, regardless of the frequency of visits. Particular services aren't paid any better: x-ray 6 € per patient/quarter; ultrasound 0,36 €. Consultancies manage to survive on cross-subsidisation by patients who don't "use up" their quarterly budget or, more importantly, by private patients.

 

This may explain why your wife had the impression of assembly line treatment and the doctor didn't seem to dedicate the necessary time. Maybe she should still give the prescribed therapy a chance for a certain period of time. If it seems completely pointless to see this doctor again, maybe talk to your health insurance, as recommended by others, about specialists in pain therapy. There's also the Schmerzambulanz of the Uni clinic in Bochum. It is advisable to be referred (get an Überweisung) by your doctor in order to get an appointment there. Perhaps the interdisciplinary approach that this clinic department uses would be more successful. I hope your wife finds adecuate help soon.

 

EDIT: Lorelei beat me to it with regard to Bergmannsheil clinic.

4

Share this post


Link to post
Share on other sites

Without wanting to be alarmist, it is worth Googling the possible side effects of chiropractice, just for the sake of being well-informed, in the same way as you are when you try a new medicine. I just say this as many people see it as being a totally harmless alternative.

3

Share this post


Link to post
Share on other sites

I've had a lot of help from chiropractic for low back pain. Slipped a disc back in my 20s and it was the only thing that got me back on my feet. I know the OP has already tried it, but not sure if she has tried acupuncture like was recommended. I was helped with some shoulder pain through acupuncture.

1

Share this post


Link to post
Share on other sites

I hate suggesting antibiotics when there is no need for them, but recent research suggests they might actually be helpful ina lot of chronic back pain cases:

 

http://www.guardian...k-pain-patients

 

As to how you find a doctor willing to prescribe them, it seems just telling some German doctors you have a nasty cold might work ;)

0

Share this post


Link to post
Share on other sites

I don't know where you moved to Germany from, but can your wife contact her former doctor who is familiar with her condition and have him/her suggest a treatment? Depending on that answer, she may have to return 'home' to get it done, get a prescription for pain or a therapy you can translate into German. Medical marijuana might help while she waits.

1

Share this post


Link to post
Share on other sites

Off topic but I just want to throw in that your wife is a lucky woman to have such a caring husband.

 

Often, chronic pain can effect both almost equally. Take care of yourself.

 

Moistly,

fraufruit

3

Share this post


Link to post
Share on other sites

Thank you all for your suggestions and advice. I'm the OP's wife. I doubt if it is a slipped disc problem as 2 MRIs of the lower spine have shown no such problems. What I have is actually a severe pain in the butt which radiates to the knee and down to the calf n foot on the bad days. Terms like bursitis, IT Band syndrome, pelvic pain syndrome have been tossed around by doctors. Some ruled out arthritis, and a couple of them have mentioned fibromyalgia.I have been doing some online research and thought it might be piriformis syndrome, but then in the last couple of years the pain started switching sides. Like a bad migraine, some days its on the left some days on the right and on the really bad days, on both sides.I have been looking for alternate options instead of having to take pain medications daily but am so tired of trying for so long I'm now open to pain killers on a daily basis. I quit my job 3 years back as I couldn't sit for 9 hours. The shoulder pain started after starting violin lessons 3 yrs back. I stopped the lessons but the pain has worsened over time.

 

I have been to a chiropractor in US and in India. It didn't help me so I do not want to go to one here. Just before coming to Germany we found a pain specialist in India who gave me some cortisone shots and used acupuncture. The combination worked well and I could actually go a whole week without taking any painkillers. I just wish we had found him earlier. We tried contacting a pain clinic here, they gave us a multi page questionnaire fully in German and they didn't have an English version so we contacted the earlier mentioned orthopedic. Before trying this, we went to an acupuncturist. She was as warm and friendly as an iceberg, also she kept asking me if I had consulted an orthopedic yet, which made me feel she wasn't really hopeful that her treatment would help (and it didn't). I still believe the right acupuncturist might be able to help but how do I find one. Today I went for the first session of acupuncture prescribed by the orthopedic, we went hoping to talk to him but he wasn't there and a nurse just came in and put in some needles and walked away. Not a single question on where I had pain. I have decided not to go there again. The pain specialist in India would probe my trigger points in the painful areas and use the needles accordingly. I guess that helped reduce the pain. I had come across the article on antibiotics and back pain but again you would still need a doctor here to listen and prescribe the antibiotics. Despite telling the orthopedic that usual painkillers have never helped me he prescribed ibuprofen. I really doubt if the guy actually listened to me.

 

I will go to a GP nearby and see if he can refer me to the Bergmannsheil clinic. I just want someone who will be willing to spare a few minutes to listen and understand my situation instead of simply prescribing ibuprofen and therapy. I have suffered thru bouts of migraine in my teens and have a good tolerance for pain. I only complain when it's unbearable and I just wish the doctor would listen. I do not really care how he can bill the Krankenkassen, if it's so difficult for him perhaps he should refuse to see patients with public insurance beyond a limit than make them go through such trauma.

 

Thanks again for all your responses, if you have any other helpful suggestions please do let us know.

5

Share this post


Link to post
Share on other sites

 

I do not really care how he can bill the Krankenkassen, if it's so difficult for him perhaps he should refuse to see patients with public insurance beyond a limit than make them go through such trauma.

That's one of the problems. He can't.

Maybe you should really try the pain clinic again, get the questions translated instead. I really don't want to sound rude, but better get used to the fact that you live in Germany. They have to tell and ask everything of importance in German. It's Amtsprache, and you are lucky if you meet a doctor who is comfortable speaking English. And maybe they don't listen because they don't really understand you. Reading and understanding English and listening to a native speaker and understanding English are two different things.

 

Have you tried smoking dope? (Yes, it's a serious question). A friend of mine has chronic pain from nerve damage after chemo and it's the only thing that helps him.

1

Share this post


Link to post
Share on other sites

I'm sorry but I haven't experienced any of the negative opinions stated. I have public insurance and have had surgeries/treatments in private clinics. Nor have I had a problem finding doctors/dentists that will speak English with me. If they won't, I find another one. Even now when I can do most things in German. My health is a different issue.

 

Please don't be discouraged.

0

Share this post


Link to post
Share on other sites

Based on what you have written earlier: thyroid, insulin resistance, chronic pain without trauma, nerve pain switching sides, etc., it could be a number of things, but it sounds to me like the sugar handling problem is underlying all of those problems. As a doc who works with nutritional and systemic issues on a regular basis, I have had people like this in my office. Tried chiropractic, (didn't help), tried GP (didn't help), Cortisone (didn't help). Wacking on the spine doesn't solve everything (though a lot of things), suppressing the symptoms doesn't get to the cause of the problem and the side effects make things worse, and cortisone is less than 50% effective and I would argue based on my patients' reports less than 25%.

 

Sugar is like cigarrettes were back in the 50's and 60's. Back then they actually thought they were good for you. Sugar can cause nerve parasthesias, especially in diabetics and insulin resistance is the first step to Type II. Blood sugar fluctuations affect metabolism and eventually the thyroid starts to dysfunction (after adrenals). Fibromyalgia tends to be a catch all diagnosis sometimes that replaces the diagnosis of "IDHAC Syndrome" or "I don't have a clue". Fibromyalgia often responds to b12 supplementation although it may take some time. For nerve pain, B6 is often helpful especially carpal tunnel pts with nerve parasthesias.

 

In the end, here is my suggestion. Find a doc, homeopath, chiropractor, osteopath, whoever, that will actually look at systemic causes for what seem to be mechanical problems. Someone to test for candida infestation, maybe even silver amalgum toxicity. They can cause problems similar to what you describe, especially if there is a sugar addiction. Not to market myself, but I am from the US, so english is fine and I work in Munich. If you have more questions, please feel free to send me a message...

 

 

The above information is only for informative purposes and not to be taken as medical advice, medical recommendations for your personal case, or to instruct how to treat yourself. Before taking any drug, herb, or supplement, consult a proper health care professional.

6

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!


Register a new account

Sign in

Already have an account? Sign in here.


Sign In Now