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Old 01-10-2012, 11:04 AM   #1
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Do I need to take medicine if my pain is moderate?

I will see a new Neurology tomorrow for my persistent right leg pain. I had low back and right leg pain since May 2008 because I had a big herniated disc at that time. The low back pain almost gone after doing some treatments but the right leg pain became persistent .Recently my pain management doctor did a discogram to me but didnít find any positive disc which is causing my leg pain. So he sent me to this Neurology and hoped the Neurology can explain this pain. I think the Neurology may let me to do some tests such EMG again which I already had done two times. If he let me to try medication, I think I need to ask question,
My Pain only is getting worse when I walked or stood too long time. The pain scale is about 4-5 If I take rest , it will calm down to 2-3. It starts to ďdistracting ď me but I still can live with it. I donít know if I need to take the medication and also take the medicationís side effect or just live with this pain since it is not unbearable? But if I refuse the medications, I
donít know what else method he still have and can be used to me?

Thanks!
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had persistent right leg until now.
have Osteoporosis, subacute thyroidits.

Last edited by efang; 01-10-2012 at 11:10 AM.

 
Old 01-10-2012, 12:21 PM   #2
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Re: Do I need to take medicine if my pain is moderate?

It al depends on how much pain you are willing to live with. I take LA meds with BT meds if needed. I have learned when to take the BT meds so i am not chasing my pain. I live with constant pain and my meds bring me to a 4-6 on good days

 
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Old 01-10-2012, 12:32 PM   #3
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Re: Do I need to take medicine if my pain is moderate?

I am sorry what is " LA meds" ? if your med can bring you to 4-6 on good days.
your regular pain without meds should be 7-8. right?
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Old 01-10-2012, 01:11 PM   #4
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Re: Do I need to take medicine if my pain is moderate?

seems to me you have answered your own question-you say your pain is not unbearable and you say you can live with it-if my pain stays around/at 5- i am thrilled-as that is a successful feat in chronic PM-iif your pain is moslty 3-4 you probably wont need LA(long acting)pain meds at all. if you can manage your pain without rx medications that is wonderful and consider yourself lucky! good luck
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Old 01-11-2012, 09:03 AM   #5
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Re: Do I need to take medicine if my pain is moderate?

LA is a long acting pain medication. Without pain medications I am constantly at a 7-8.. sometimes a 9 even.....

 
Old 01-11-2012, 10:02 AM   #6
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Re: Do I need to take medicine if my pain is moderate?

I agree with BB, If your pain is managebele with OTC, than why go through the hassle, the contracts, UA's, pill counts, having your plan changed and experiencing withdrawal each time a different doc has your chart. You also have to consider that if your n a car accident, nowmatter how normal you may feel on the meds, If yur taken to the hiospital by ambulance you will be tested for drugs and then you will be charged with DUI. Just because their prescribed, doesn't mean your safe. If a cop stops you and thinks your pupils are too small, you have a huge problem.

It doesn't really seem worth it to me and it seems the majority of the docs you see have the same opinion. Opiates were an absolute last resort for myself. I was bed wriden, couldn't walk or stand for more than 10 minutes and even with an implanted pump that delivers meds directly to my spine at best it reduces my pain to a 5 or 6. wich I consider a 50% reduction in pain and the pump manaufacturers and my docs consider it a suuccess. I believe it to be a success too, because I was able to start walking, loose some weight and even return to work part time in an entirely different field, nothing physical, why cause myself pain and create more pain for my docs to have to manage, and for me to have to put up with the side efects from those meds. Not that I don't pay dearly when I work but the benefit of getting out of the house makes it worth while.

I haven't personally met a doc that even manages chronic pain with short acting meds as needed. They feel if your in that much pain the way to manage it is with Long acting meds around the clock, All those things they want you to try are things I tried and failed many years ago, then tried them again and again before pain meds were even offered. I certainly wouldn't want to deal with the whole dependence issue and the red flags it raises at every doc and pharamcist that thinks you have no buisness taking these meds, like Gp's, other specialist etc. You may find a PM doc willing to prescribe, but I would be shocked if all your other docs aren't concerned about the trade your making, Dependence to reduce pain from a 4 to a 2 or 3? That's a heck of a price to pay if you can do without. You also have to consider that eventually the dose your taking will no longer work, everyone eventually develops tolerance, you may need 3 times the dose you need two years from now and withdrawall just gets worse the higher the dose and the longer you have been on them. a quick easy withdrawal of 10 or 14 days can become months down the road.

I understand you have multiple issues, but when it comes to talking to the doc, it really noils down to what's you worst pain generator. You can become a very complicated and hard to please patient if they can get one problem under control and then the knee blows up and next the wrists aren't being helped etc etc. Getting old sucks and if you can ease the pain by simply changing positions or jobs, that seems like a more reasonable way to manage pain than to become dependent on pain meds for the rest of your life.

IMO opiates should be the last alternative rather than an upgrade to first class from Ibuphrofen. If Ibu works, use it, try allieve, throw a tylenol on top, but to **** test monthly, become dependent, be treated like a junkie by every other doc you see, is too great a price for moderate pain IMO, but that's just my opinion, I have no doubt some PM doc will prescribe if you search hard enough. But are you getting the best care or just finding someone that has a completely different POV on the use of opiates because it's their buisness to satisfy people with pain issues. Every med has side effects and although you may not experience any now, eventually your dosing needs will bring them on and it's harder to stop the farther down the road you are. Where it's easier to find an alternatives like injections, OTC meds or simply changing your work habits to suite your physcial condition before dependency on opiates has a chance to increase or even morph into something worse.
Good luck, Dave

 
Old 01-12-2012, 08:12 AM   #7
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Re: Do I need to take medicine if my pain is moderate?

Shoreline,

Thank you for letting me know your experience and concern. I saw my doctor yesterday. He was planning to let me do one new EMG and find if I have nerve damage, then He may let me do a MRI for my leg only because he think maybe
my spine herniated disc is not causing my leg pain now. He will try to find this
reason. He asked me if I need to take medicine, He can let me try now. I refused. I just wanted if he can find the real reason of my leg pain.

Thank you very much!
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had herniated disc in L5 s1 five years ago, have
had persistent right leg until now.
have Osteoporosis, subacute thyroidits.

 
Old 01-12-2012, 09:36 PM   #8
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Re: Do I need to take medicine if my pain is moderate?

If you can get your pain to a 2-3 without narcotics....ummm...i'd not jump on the narcotics train until you just had to. Most of us havn't seen a 2-3 in a very long time. I'm on major amount of drugs after many, many surgeries and am good if I can keep my constant pain to a 4-5 on a good day...i'm good if I can get up and walk each day.....if you can manage your pain with OTC meds, heat, other therapies, then do it. Once you start the narcotics, odds are you aren't going to be getting off any time soon...

Take care,

Kat

 
Old 01-16-2012, 05:45 PM   #9
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Re: Do I need to take medicine if my pain is moderate?

Efeng,

opiates are not anti-inflammatory drug, it means it will not help your inflammation if you take it. It simple pain killer.
Based on my own experience, someone who is Chronic pain patient due to Arachnoidites as complication from failed major spinal fusions, titanium, RA, Lupus and MS - take only if you pain unbearable.

If you can live without them, if it doesn't affect quality of your life - go ahead, take Motrin, or something like it and forget about opiates. Leave it if pain be unbearable. Due to body tolerance, we get used to them, to the doses (doesn't matter how high or low they are) and we need more meds, we need to go higher in doses, and this is not fun.

I have some concern though. You mentioned having discogram and that they couldn't find the reason of your pain. Meanwhile you describe pain (all symptoms very pronounced) coming from your BACK. Do you know that this test is not 100% accurate even if performed by the best of the best? My PM, he is also Anesthesiologist (very important combination), who works at Hospital for Special surgery in NYC very open and honest about everything, discogram included.
Before 3 of my discograms he said to me to hope we will find exact reason of pain, but even if we not - doesn't mean its not there.

He performs discograms only if surgery is a big possibility. And also believes in all results together: MRI, Myelogram, CT and discogram. He always says that in something serious, x-rays are absolutely useless, which is total truth. They dont send you to discogram if MRI and other tests show nothing or something mild. It very invasive, painful test.
I want you to know that I read many times that same as nerve conducting test must be performed by a very knowledgeable Neurologist, discogram must be done by an excellent specialist. Besides these tests are not 100% accurate to begin with, if they performed not by a very good doctors - you duped.

This is why, I am concern about your symptoms. Did you ever consider to go for couple other opinions? You never put all your eggs in one baskets when comes to your health issues. I used to be so naive, thinking if I love my DR, I must trust him/her. This brought more physical damages to my body and disappointment. I am a big advocate for second opinion. Remember dear heart, if you in pain and have symptoms, your body tells you something. If doctor tells you are OK, take all your records, pictures and go to see other good doctors.
Make sure though - it must be the city or some other area, not in same area where you saw your first Doctor.
Why? They all know each other and will never give another opinion than the one you already have in your chart; trust me on this.

 
Old 01-17-2012, 09:40 AM   #10
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Re: Do I need to take medicine if my pain is moderate?

efang, you have gotten some really really great advice here. i just wanted to ask about that EMG? you stated the neuro was going to do 'another'? does that mean you have already HAD at least one done before, and on the painful leg? if so, just what were the results of that first one?

while an EMG/NCV really does have its place, about the ONLY thing that THAT type of test realistically even "picks up' is any areas of potential nerve flow impairment to the nerves tested and nothing else really. i personally have had three different ones done for different reasons. and despite the pretty over the top pain i was having with my c 6-7 herniated disc and also getting some 'intermittant' numbness and tingling/pain in mostly my forefinger, i was told that unless that particular area was actually being 'compromised/impinged" (usually more posisitionally) DURING the time of that test, it would not shopw things like simple inflammation to nerve roots, since the 'flow' was still going to be normal UNLESS that numbness returned ONLY during the test, i would STILL come out with totally normal flow velocity results. and that one DID come out normal despite the severity OF my nerve root crap and it just being a 'herniated disc' in there too. so i assumed everything was okay, even tho it hurt like heck. but i did end up having an ACDF done.

my second EMG/NCV was done two months post op from my cord surgery which most definitely DID hit and lose completely two seperate nerves on that monitor. only one came back after about a minute of complete stop of the surgery just to see if that nerve WAS going to come back,and once it did it started up its 'own' random firing. the EMG i had after THAT particular surgery was a total mess of lost flow velocitys and a ton of losses or severe impairment of most of my L hand fine motor nerves and sensory at the c 8 nereve and ITS fine motor function too(a total of 8 fine motor nerves were lost just TO that one hand/fingers, and sensory in R leg completely, and a totally screwed up motor nerve that ran to my L foot which was documented). but all of THAT most definitely showed up in the overall test results. so in THAT sense, it would show very definitive nerve flow velocity changes, esp if you have any other 'comparritives" to go by from past EMGs done there. i just went from like 'perfect" on the inital in 01 to sooo incredibly screwed up after my SCI occured in 03 it was insane.

just exactly where is this doc planning on doing that MRI on you, your lumbar, leg or somewhere else? just what 'exact" types of ongoing symptoms and or pain are you having and where specifically(what you are presenting with as symptoms and exactly where, really IS important to know, since most pain generators are possible to simply 'track back' to the underlying source just using the "appropriate" types of testing)? if the docs do not feel this is connected to the lumbar, it just has the potential to actually be in an area actually 'above' that lumbar depending upon if ANY other areas along that spinal are actually the area(s) being compromised. or it could be like a 'psoas muscle' issue too. i have three seperate pain generators all on/in that left side area that some tends to stay more around the groin up into what feels like an actual L ovary pain and also at times much lower in the abdominal, plus pain in my low back from 'just' that psoas muscle too. and a herniation with my L 4-5 that has pretty heavy L sided stenosis but suprisingly is thankfully only an intermittant crap. and also my very huge polycystic kidneys that the L one moved down and is pressing up against part of my spinal from time to time. i never really know what is the actual generator at times with all that crap just 'there'. but i DO know just exactly how that L 4-5 runs, and its a wrap around pain from low back,thru buttock then wraps around the front of the leg to crossover to, and ends up stopping right AT the inner/medial side of my knee, and no further, every single time.

once you obtain that EMG, it should show whether or not it actually shows ANY level of real nerve impairment or loss of flow velocitys going on if this is going to be done in that lag? but if you have that MRI done, i would seriously see if you can just have one done from the c spine on down thru the lumber just to rule out ANY potential generators that CAN be stemming from just about anything from ABOVE the actual pain area. its just the way our spinal 'is'. or if he is ONLY doing that leg(first see if he CAN just go from that c spine just to 'rule that out" too. since you ARE going to just be inside that tube anyways)? make darn certain that he adds a contrasting agent to the MRI order, since this really can help to 'highlight' certain types of findings that just do not always show themselves really well without using contrast.

so ALOT about just what will or wont get picked up with EMG really DOES depend upon what IS or is not actually showing itself 'during' the actual test. so if nothing actually 'shows' as an 'abnormal test", don't be too suprised. this is just a highly speacific 'type' of test looking for only ONE thing, nerve flow impairment.

trying to actually 'find' any real true diagnosis really comes down to just testing ALL possible connections TO that pain site/area(or any true actual 'triggers' that brings on symptoms and ruling things out or in along the way. sometimes it can take while, esp if your doc is not the 'motivated type'? and these just are the types of docs/specialists ypu sometimes just have to take it apon ourselves to push a bit along the way just to get our very real needs met. but i do agree with the others here, honestly efang, if you just CAN get by without having to turn to any types of narcotics, that much better off you are here,and in sooo many different ways. there are also other 'types/groups" of meds that can also help with what is more of a radiculopathic pain that work much more effectively in many cases than any narcotic would for some. if your pain for the most part is actually even close to UNDER a five, that IS a huge thing. i wnet into PM with untreatable spinal cord pain syndromes from absolute hell and could only find anything that worked for "only' my pain that responed to narcotic therepy. my other hidious pain syndromes i have just been forced becasue these suckers are "there" with one like becoming just 'my skin' now with horrid stinging with sick flares to have to accomodate this crap inside my brain over time. our brains DO have the capacity to help us adapt and to also somewhat disassociate from even the worst types of pain only when we are 'forced' by circumstances beyond our control to simply even have to feel its intensity like in my case with the central pain, 24/7, and it never ever goes below about an 8 now, where what i NOW considwer to be an 8, but used to be immediately after simply waking up in the recovery room, like honest to god, a 200 plus(i honestly wanted god to just take me after THAT digging into my spinal cord generated soo much pain and sick syndromes to have to 'deal with. just THAT bad). the worst freaking pain i have ever had to deal with that is still here since 2003.

my 'goal' when i had to fill out all of the required paperwork before my initial appt with my PM, i stated getting to at LEAST a five was what i did believe at that time to just be 'tolerable' for me. i am STILL waiting to get there. so honestly efandg, being at where you are right now, is NOT too overly bad if any OTC can actually even touch this and bring it down even more. you just really DO need a real Dx for that leg pain. just stay on top of all docs you see til 'they' find you some real solid answers. good luck efang, marcia


hey mol, really missed ya girl!
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3-22-01,herniated C-6-7
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9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

 
Old 01-17-2012, 11:39 AM   #11
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Re: Do I need to take medicine if my pain is moderate?

Quote:
Originally Posted by Moldova View Post
I have some concern though. You mentioned having discogram and that they couldn't find the reason of your pain. Meanwhile you describe pain (all symptoms very pronounced) coming from your BACK. Do you know that this test is not 100% accurate even if performed by the best of the best? My PM, he is also Anesthesiologist (very important combination), who works at Hospital for Special surgery in NYC very open and honest about everything, discogram included.
Moldova,
Thank you for your opinion. Yes, I knew discogram is not 100% accurate .My PM doctor did it to me. He is pretty good doctor and I trust it. He tried to find the exact reason of pain but he failed -doesn't mean its not there.
Now I am waiting to do new EMG on Jan 25 , I think it at least can give me new information about my nerve of leg. then I may do a new MRI. I will see the result then continue discuss here.
Thank you very much!
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had persistent right leg until now.
have Osteoporosis, subacute thyroidits.

Last edited by efang; 01-17-2012 at 11:40 AM.

 
Old 01-17-2012, 12:15 PM   #12
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Re: Do I need to take medicine if my pain is moderate?

Efeng,

this is exactly what I want to hear from you: you dont stop. And of course you right, our doctors just humans, they cant do miracles. My Neurologist, PHD with long years of practice told me ones that unfortunately doctors know less than they dont know and if they would have all the answers, it would be miracle. But they dont do miracles.

Your symptoms remind me of symptoms my dear friend had. Her husband is GP, MD and believe or not, it took her 2 years to finally being diagnosed. Eventually, she had to have spinal surgery (very mild though) and after it for many years now she is in great shape.
This is why I got concern reading about your symptoms thinking I hope he will pursue it further to get all the answers needed.
MRI is a great test to get many answers; in some cases CT can be helpful as well.
EMG test is not 100% accurate as well, a lot to do with who is doing, but I hope it will show either you OK or have some changes there.


Best of luck to you!
Moldova

 
Old 01-17-2012, 05:50 PM   #13
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Re: Do I need to take medicine if my pain is moderate?

Feelbad,

Thank you for letting me know your EMG experiences . I had done three time EMG in one PM doctor office ( not my current PM doctor) , All reports show I had some kind of nerve damage in my right leg. But right now my new doctor wants me to do a new EMG , he said he will do his way to find out what is my nerve status RIGHT NOW. He think Spine disc is not causing my leg pain NOW ( I personally agree with him) .My MRI report also shows my herniated disc already became smaller and canít explain why my leg still has this kind of pain but my back almost has no pain. When I done this new EMG. He will let me do a new MRI for leg only because he think maybe my leg has some problem which is not connecting with my lumber spine . I will let all you know the result.
Thanks!
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Old 01-18-2012, 08:57 AM   #14
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Re: Do I need to take medicine if my pain is moderate?

it just IS very highly possible efgang. the nerves that run FROM our lumbar on down into the S nerves within that spinal DO also simply run on down into our legs too, so any number of 'things" could also be impinging the nerve from beneath that area where the spinal just ends too(not to mention the SI joints and any others too). bloodflow is another area that if impaired in some way can screw up the sensory as well.

if you actually had your own copies of the previous EMG/NCVs to compare this new one to, it would seriously help to see what IS still possible 'abnormal or normal" right now and what WAS then as well. this would show progression of something or something that has kind of "righted' itself over time. but those EMG results done before would contain ALOT of info if just anything was impaired at the previous testing.
this is why docs simply 'do' comparritive' types of testing at all, just to see what may have changed.

but i would VERY highly recommend to anyone who has had ANY actual testing to make 'certain' to always, always obtain their very own copies of 'their' own results. i have like every single lab test(many or those for my liver and kidneys) along with MRIs, EMGs ultrasounds CTs, whatever that test just IS, you 'deserve' your own copy for your own files. this makes it much easier to not only always 'know' what showed or did not show in every test you have had(most importantly that you just ARE also being told everything by the ordering doc too), but to do your 'own comparrives' to them whenever another is referred for you to just have too. i just have everything that has ever been tested on me, and believe me, my PC room looks like a medical records room, but i KNOW exactly what every test stated, and i also obtain the overall clinic notes/medical records from EVERY single doc/surgeon and surgery i have seen/had as well. you just can never have "too much information' on YOUR own body as a whole.

it would be very interesting to just know what the other EMGs actually showed as 'impaired/abnormal' tho. they usually write flow velocitys right next to whatever nerve/muscle is being tested, and it will also usually state "abnormal or normal test result" too. tho it will not say the "whys' of that flow result, it WILL let the doc know that it was not normal, and the docs kind of take it from there with at least something to 'just go on'.

if you have not yet opbtained any and all results from each and every test you have had done, you can either obtain them thru the ordering doc, or from the actual facility that did them too. but DO keep track of all of this for YOUR own personal medical files. trust me efang, mine have come in sooo flippin handy over the years, and my youngest sons too who i have been doing the very same thing for with what started out as a liver failure and then thankfully tx way back in 99-2000, but he also unfortuently has suffered many other medical nightmares too. it allows ME to just know whats going on with my son, test wise. just obtain one of those expandable type of forlders and keep everything in that so it is portable if needed too(specialist appts, ER or any other place you may need to take your medical info like even on a trip too).

hopefully the EMG will show something that can just be better pinpointed. good luck fang, marcia
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3-22-01,herniated C-6-7
11-20-01,placement of hardware for failed fusion
9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

 
Old 01-18-2012, 02:49 PM   #15
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Re: Do I need to take medicine if my pain is moderate?

Feedback is very right about copies of any of your reports, xrays, etc.

I keep all of them; my husband could never understand why do i have tons of these heavy big envelopes with films and reports, but when I switched surgeon before my second spinal surgery, his office (before even seen me) requested all films, reports to see if he can really can help me. I didn't have to run to collect them: they were right in my home. We tend to forget when and what we had done, so in your best interest to keep them safe.
Not to mention 7 years ago when my resent mammogram was abnormal, they lost all my films for 12 years and had nothing to compare with.
So now I dont have to worry about stuff like that.

efeng,
Just a thought: did you ever have MRI of your hip? You wouldn't believe but your leg nerve/pain/problems can be in hip area as well.

Wishing you well
Moldova

 
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