If you have had a cortisone shot that did not work and take pain medication that relieves pain by heat is a psychiatrist the next medical intervention?

Answer 1

There are 2 reasons people usually ask this question - they've been given an anti-depressant drug, or they're in a formal pain program and have been referred to a shrink or LCSW.

If you've been prescribed an anti-depressant, it's not because your doctor suddenly thinks you're nuts or the pain is in your head. Anti-depressants (certain ones) are used in conjunction with some opiates/ opiate analgesics because research has shown that they augment the pain controlling features of the painkiller being taken. While the mechanism isn't fully understood yet, actual results vary with each patient. For me, it never worked much, but I'm an extreme case on several levels.

If you're in a formal (or even informal) pain program, seeing a shrink or LCSW is just part of the overall treatment plan. The reason is that anyone with long term chronic pain will face depression at some point - it's just inevitable. Family problems, cultural pressures, job pressures, not being able to do things we used to, etc., all lead us down the path to depression. Knowing that, pain specialists and other doctors make sure that it's part of any treatment plan. If dealt with early on, the patient is able to understand what's happening and can cope with it better.

So while it's likely not the next step, it's probably just part of your overall treatment plan. Don't take it personal. I underwent counseling for 3 years in the first few years of my own pain management. I also learned I can't take anti-depressants.

TSD -RAVEN- Category Supervisor

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For me, when a cortisone shot does not work, it is often the case that the surrounding muscles and tendons are "angry." So, to relieve that, I need to stretch my muscles and that seems to relieve the issue for the moment of exercise and then, overtime, as everything calms down. If you can go to a water class (Arthritis Foundation can recommend some with warm water and good teachers), a physical therapist can show you some good moves for the area, and/or look for an experienced trainer teaching a novice stretching class. A psychiatrist can prescribe an anti-depressant which often helps with pain management...it does not mean that the pain is in your mind, but that you need additional seritonin to help. (see link) Also, you might consider acupuncture.