Atypical or uncommon pain pesentations

With undergrad in kinesiology, grad in chiropractic and over 2250 hrs post graduate studies, (including 3 yrs occupational health, 3 yrs rehabilitation, 3 yrs whiplash assoc. disorders) .. one might say I have the training for examination & treatment of many pain disorders. Prior equestrian & skiing injuries lead to 3 consecutive compression fractures and in 1996, I had spinal surgery & stabilization via titanium cage in vertebral body of T8 and pedicle screws T7 & 9. This forced me to retire from private practice & 10 years later also my resignation from concurrent efforts on provincial & national Board of Directors. In 2002 after consult with London pain specialist, I started opioids & for next 15 yrs was stable - no neg. side effects, no tolerances built up, no changes required - good status quo In 2016 GP & specialist both retire same time. New GP is insulting, prejudicial, falsifies records & when I insist on consult with CPSO pain specialist, GP refuses to accept those recommendations. Last 2 years no Rx .. ADL & QoL destroyed .. great for LCBO.. not me !! Important to note that neurologists .. ARE NOT NATURAL PAIN SPECIALISTS .. esp for any condition different from what they usually see. In 1996 in GTA, 2001 in London & 2019 in TBay ..three different neurologist consults consisted of exact identical exam ..which was totally inappropriate, irrational & irrelevant !! Not one talked about, tested or touched the thoracic spine. Instead the exams were for standing cervical ROM/range of motion and standing lumbar ROM, then sensory testing via soft brush & pin wheel on arms (nerve supply is cervical !!) and on iliac crests (nerve supply is lumbar !!) ..nothing THORACIC. Furthermore, contrary to the research, when I advised about my ergonomic modifications for ADL & daily exercise routine including push-ups, I was told not to do that .. duh ?? When I was in private practice, many times I had to educate insurers through my reports, that ribs DO move with every breath and these have delicate intrinsic ligaments to allow ROM & ribs have good nerve supply, all of which can be damaged during MVA when driver holds steering wheel to brace upon impact. Unbelievable that MDs & neurologists have forgotten this. Research talks about post-thoracotomy chronic pain (i.e. surgery on lungs or heart) being common and difficult to deal with, and yet 7 chronic pain & opioid Rx guidelines I have read, only mention low back pain, neck pain, RA & fibromyalgia. It is for this type of less common presentation especially, that a multi-discipline approach would be optimal - esp if the person is doing all the appropriate non-pharmacological activities research supports & psycho-social factors are negligible (can't be zero with chronic pain) FYI ..my father had similar situation. He continued hard labour for 2 years with several prolapsed IVDs and had surgery in 1970's (when it was 'hack n wack' so 2 years later had to have surgery again for extensive scar tissue. But all through this and until his death at 93 yrs, he exercised daily doing full military pull ups & push ups & worked with weights and 5 km daily runs. But after cardiac surgery in his 80's, he stopped his hobby of making wood furniture & gardening and so much else, because of the thoracic pain. With a little bit of Percocet, he was back to everything until his death. In addition to deficiencies of expertise for atypical conditions (where multi-discipline would benefit) .. the current incorrect & unfounded equation of street opioid problems and chronic pain patients ..is outrageous and should in itself be criminal!! Change the protocols to address the VERY few who get addicted from Rx ..ie. opioids for 48-72 hrs post surgery - not 6-8 weeks !! The vast majority of chronic pain patients, as per the research, do not abuse narcotics. While fentanyl was effective, my skin couldn't handle the trans-dermal patches, so I went off them .. cold turkey ..no problems. When the replacement GP took me off the opioids that I had been on & stable with for 15 years … no withdrawal symptoms whatsoever !! Just pain ..4-5/10 upon rising … 7-8/10 mid-later day ..and 8-9/10 with certain activities.