Tag Archives: pain clinic

Living with LPHS

I am a 43 yr old female with a long history of kidney stones going back 18 yrs. 2 yrs ago I started having chronic left sided kidney pain with the same type of symptoms as the stones however no stones. It has taken me the full 2 years to convince the medical community I am not a drug addict nor am I suffering from a mental disorder of any kind. I am currently being treated by the pain clinic in my area and along with oral narcotic medication I am getting injections into the nerve area around my kidney with long acting anestetic medication. I am not free of pain and still have much breaktrough pain. I feel at a loss here as no one seems to have a long term solution. I would welcome any help anyone can offer.


Agreement form recommended for use before opioid treatment is prescribed

I understand that Dr ____________ is prescribing opioid medication to assist me in managing chronic pain that has not responded to other treatments. The risks, side effects, and benefits have been explained to me, and I agree to the following conditions of opioid treatment. Failure to adhere to these conditions will result in discontinuing the medication.

  1. The medication must be safe and effective. The goal is to use the lowest dose that is both safe and effective.
  2. The medication must assist me to function better. If my activity level or general function gets worse, the medication will be changed or discontinued.
  3. I will participate in other treatments that Dr ____________ recommends and will be ready to taper or discontinue the opioid medication as other effective treatments become available.
  4. I will take my medications exactly as prescribed and will not change the medication dosage or schedule without Dr ____________’s approval.
  5. I will keep regular appointments at the pain clinic.
  6. One doctor. All opioid and other controlled drugs for pain must be prescribed only by Dr __________.
  7. If I have another condition that requires the prescription of a controlled drug (narcotics, tranquilizers, barbiturates, or stimulants) or if I am hospitalized for any reason, I will inform the pain clinic within one business day.
  8. I will designate one pharmacy where all my prescriptions will be filled.
  9. I understand that lost or stolen prescriptions will not be replaced, and I will not request early refills.
  10. I agree to abstain from all illegal and recreational drugs and will provide urine or blood specimens at the doctor’s request to monitor my compliance.

    Signature: ___________________________________

    Date: _______________________________________

    Signature: ___________________________________

    Date: _______________________________________
    (Chronic Pain Management staff)

Canada – The Victoria Pain Clinic

The Victoria Pain Clinic “Western Canada’s Residential Treatment Centre for Chronic Pain and Stress”

The Victoria Pain Clinic is a proven residential treatment centre serving clients who suffer from chronic pain and/or chronic stress. It is most suited for those who have not responded well to conventional therapy or wish to explore an alternative to drugs or surgery. A large portion of our clients have had accidents or surgery and are still in pain after the normal healing period has elapsed (more than 3 – 6 months).

The Victorian Pain Clinic
365 Hector Rd., RR#3
Victoria, BC CANADA V9E 2C3
Phone: (250) 727-6250
Fax: (250) 727-7358
Email: [email protected]

Find a pain specialist or pain clinic in your area

American Pain Foundation has a searchable database on its website under Finding Help.
Phone: 888–615-PAIN or 1-888-615-7246
Web: painfoundation.org

American Academy of Pain Management has a searchable database of medical facilities that have passed the American Academy of Pain Management’s Pain Program Accreditation testing and on-site inspection.
Phone: 209-533-9744
Web: aapainmanage.org

Pain.com has a searchable list of pain specialists and pain clinics all over the globe. Each of the specialists and/or clinics is listed in postal code order with the complete mailing address.
Web: pain.com/painclinics