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No, they have it. Nor should they. Referral to a pain specialist might sound good when reviewing policy, but this option has many flaws.There is one pain specialist in this county, and there are none in three adjacent counties. While “Dr. A” is a caring physician, sometimes he and patient do not connect well. I have had as many as 120 nursing home patients at a time. Many have chronic pain. Dr. A does not go to nursing homes for monthly assessments and additional needed visits.Opioids have deficiencies. That is part of why I became skilled at the use of methadone and buprenorphine and certified to use Suboxone.Use nonopioids, some say. Use “SNRIs and/or alpha 2 delta ligands“ we are told. Per Beer’s List in the elderly we are to avoid chronic use or use with caution NSAIDs and SNRIs. The gabapentin package insert reads, “The types and incidence of adverse events were similar across age groups except for peripheral edema and ataxia, which tended to increase in incidence with age.” These are the chief impediments to use at any age, and they worsen with age. For pregabalin the most common adverse effects are dizziness and somnolence. One in seven stop the medication due to inability to tolerate side effects.Opioids have a role in chronic pain. Primary care physicians prescribe them as pain specialists are scarce. Indeed pain specialists often pass the patient back to primary care as they are too busy to continue care. Just ask patients trying to book new patient appointments.

There are no legitimate sites online for getting or registering an ESA OR a service dog. They are all scams. If you think an ESA would be beneficial to you, discuss it with your primary care physician, and get a referral to a psychiatrist who can determine your need and write you a letter. Letters are specific to air travel or housing. Why pay money for a Dr who will never see you to write a letter that a Dr who gets to know you personally could do with no cost to you if you have health insurance to cover it. The only reason to use these websites is to get a letter for someone who knows they don’t actually need the ESA, but just want their pet to travel with them or live in a no pets home.

If you really do have narcolepsy, you'll likely need to see both, and that'll just be for starters. You'll probably need your primary care doctor to give you the referrals your insurance will require to see the many specialists you'll need. And, since the journey to getting a diagnosis can be a long and frustrating one, your primary care physician should be someone with whom you have a good, trusting relationship.At some point, you should see a neurologist to rule out neurological disorders. Since untreated narcolepsy can look a whole lot like certain psychiatric disorders, especially bipolar disorder or clinical depression, you might be required to see a psychiatrist or a psychologist for a screening. Although narcolepsy is classified as a sleep disorder in the Diagnostic and Statistical Manual of Mental Disorders, a psychiatrist alone cannot give you the diagnosis.If you can bypass the psychological screening and go straight for the sleep doctor, I highly recommend you do so. You can always go to a psychiatrist after you've seen a sleep doctor, but much too often, if you get misdiagnosed with a psychiatric disorder first, it can be hell getting anyone to look beyond that. Also, psychiatric meds can and will wreak havoc on your body and brain, making your sleep problems worse.Your goal should be to get to a sleep doctor. You'll want to look for a specialist (preferably one in Internal Medicine or Neurology) who is BOARD CERTIFIED IN SLEEP MEDICINE with expertise in sleep disorders. I cannot stress that enough. Many times, doctors will be listed as sleep doctors, or even under the heading "sleep medicine", but will only be board certified in pulmonary diseases or something else, not in sleep medicine. So, they *are* sleep doctors, but they specialize in things like sleep apnea, not the more rare disorders like narcolepsy. I've also met doctors who were board certified in sleep medicine but who had very little experience treating narcolepsy. I'm sure they'd do fine with continuing treatment, but I'd want someone who's very familiar with narcolepsy to make the diagnosis.Once you get to an internist or neurologist who is BOARD CERTIFIED IN SLEEP MEDICINE, he or she will ask you about a thousand questions, have you fill out countless surveys, and ask you to keep a detailed sleep journal, probably for two weeks. (Fill that thing out like your life depends on it's accuracy, because it kind of does.) You should have blood work done to check things like hormone levels. You'll probably be referred to other doctors for evaluations if you haven't already. You'll try things like melatonin and light therapy and improving your sleep habits. Then you'll have an overnight sleep study. Or, you may have the sleep study shortly after you complete the sleep journal. It doesn't really matter.If your sleep doctor still thinks you may have narcolepsy, he will order a second overnight sleep study and a daytime MSLT (Multiple Sleep Latency Test), which is the standard for diagnosing narcolepsy. You must sleep at least 6 hours during the overnight test, then you must stay awake for the daytime test, except every couple of hours you'll be asked to take a 15-minute nap. People who slept at least 6 hours the previous night shouldn't fall asleep within that timeframe, and no one should really enter REM sleep during a mere 15 minute nap. No one, that is, but someone who has narcolepsy.Narcolepsy is associated with specific disruptions in brain wave patterns. You experience excessive daytime sleepiness even after a full night's uninterrupted sleep because you don't get enough deep sleep, or delta wave sleep, and you usually get too much REM sleep, though not at the normal times in and not in the normal patterns.I know for me, I used to go through periods where I couldn't sleep for days no matter what I tried, then I could sleep for two or three days straight, only waking up every 12 to 20 hours just long enough to eat a little something and use the restroom. But, even after all that sleep, I felt like I hadn't slept for days. I had no energy, couldn't focus, and my memory was so bad I was even tested for things like Parkinson's Disease. It was terrifying to be told of conversations I'd had or places I'd been and have no memory of it. One time, I commented on a beautiful painting and my husband told me I said the same thing every time I saw it. I told him that was impossible because I'd never been to that building before. Then he explained it was our third time there in as many months. It's like living in the Twilight Zone.Your brain doesn't get the deep, restorative sleep it needs for proper functioning and memory formation, so it steals little bits of sleep every chance it gets. It might only be for a few seconds, or it might be for the better part of an entire conversation or experience. It steals the bits of sleep in a desperate attempt to make up what it's lacking, but the sleep it steals isn't even quality sleep, so it does nothing but rob you of your life. It totally sucks.But, with the right doctor who's BOARD CERTIFIED IN SLEEP MEDICINE, the right medication, good sleep habits, and lots of support, it does get better. I mean, it gets so much better it'll feel like you're living someone else's life! Sorry if I answered more than you asked — it's my first time answering anyone. Good luck!