jajackson
08-15-2004, 07:35 PM
I have been dealing with chronic back pain for about 10 years (I'm 30 now), and I had my first back surgery 2 years ago (L5-S1 discectomy). Well I'm still having back pain throughout the rest of my back so come to find out I have another hern. disc at C7 and my left leg is burning again like before surgery. I have been seeing a pretty good fam. practice Dr. and he's tried to be very thorough. He's ordered about 30-40 different blood tests to rule out anything artritic, or muscle related, he even tested for cancer, lupus and lime disease. Of course everything came back normal. And during all this time he's tried me on about 6 different anti-inflammatories, he says they "should" be helping. Well they don't... at all. I have been on so many different pain meds since my surgery, mostly hydro/apap, that nothing seems to be working anymore. And the vicodin is the only thing I've tried that works if I can take about 10mg or more. But he doesn't want to rx vicodin, especially the higher mg. Anyway, my main question is.. is it possible to get to a point where no matter what you take for pain, nothing works anymore. I even tried Kadian, because he thought it would be better that taking a bunch of vicodin everyday. But nothing. So I left his office last monday with a prescription for tramadol and 1 refill, thinking I probably will just have to learn to manage this pain on my own. I'm going to try and get steroid injections in my 2 hern. discs, but I don't think that will take care of all my back pain (oh and tmj too). Anyone have any suggestions? I also have a referral to a Rheumatologist, do you think they might be able to help me? I don't want to give up. But I've tried everything in my power (chiro, acupuncture,PT,heat,stretching,exercise, etc.). I don't know what else to do. Please help. Any reply is appreciated.
Thanks.
Amy.
Thanks.
Amy.
Sponsor
Kissa
08-15-2004, 09:37 PM
There are some 100++ forms of arthrits, many of them are not detected by any means other than process of elimination or opening up the joint and actually looking at it. There are also syndromes and other illnessess that cause severe chronic pain that often go undiagnosed in many individuals. But it does sound more like you have a bad back in general and are in severe pain.
I doubt that one would ever get to the point that nothing works anymore, even dying cancer and full blown AIDS patients are able to get to a degree of comfort so it is possible for you to get some sort of relief.
First off, you honestly should be seeing a pain management specialist, not a GP. PM's are far more qualified at understading CP and how to properly treat and medicate than a standard GP. Furthermore, most GP's will not prescribe what is sometimes needed, stronger pain medications, to treat a patient due to various drug laws within your state and global laws as a whole.
A rhuematologist will not be able to help you much more than your current doctor is with a regimin of antimflamatories and possible pain medications that may not be effective for you. He might give you SI injections, personally I would not have them done because they only end up causing more damage than it's worth in most patients. SI injections are not intended for the spine even thought doctors do this on a regular basis. The medical information sheet that comes with such medicines even clearly define what they can and can't be used for and back or sacrial (sp) joints are explicity stated as one of the joints were steriods should be injected to. Ultimately it's your decision if you wish to go ahead and decide to do them.
Once you find a good PM you need to understand a few things:
It is never the goal of a PM to give you 100% relief. Some believe that 50% is adequate, other's shoot for a little higher. Mine shoots for about 70% depending on type of pain. So it is something you must accept and go in realizing.
Pain management as a whole is not just about medications it involved many things and often times a good PM will require that you partake in many of the other treatments such as:
Pain management classes - often lasting 6 weeks or so you learn methods of physcial activity such as stretching, or water aquatics to help keep the joints limber and reduce pain. You also learn such techniques as biofeed back and focusing to help you through the moments of most difficult pain. They also give you advice on lifestyle changes. Some things inevitably make the pain worse, some of those are things we love, so basically they help you to come to grips with these issues. A psych. can also help you with that.
Psychological services - many times the do request you see a pschologist or psychiatrist who deals in pain management to learn how to cope emotionally with the pain as well as your loved ones. All pain patients as some point do get depressed, this is normal, it doesn't mean you need to be on antidepressants however. Unless you have severe depression or depression on a daily basis there's no need to be on such medications unless it is for sleeping. But it is important to accept your pain and deal with it appropriately.
Alternative therapies - some will reccomend a TENS unit to help mask pain, others might suggest physical therapy. There is a host of various alternative therapies that compliment the standard pain medications.
--- more ---
I doubt that one would ever get to the point that nothing works anymore, even dying cancer and full blown AIDS patients are able to get to a degree of comfort so it is possible for you to get some sort of relief.
First off, you honestly should be seeing a pain management specialist, not a GP. PM's are far more qualified at understading CP and how to properly treat and medicate than a standard GP. Furthermore, most GP's will not prescribe what is sometimes needed, stronger pain medications, to treat a patient due to various drug laws within your state and global laws as a whole.
A rhuematologist will not be able to help you much more than your current doctor is with a regimin of antimflamatories and possible pain medications that may not be effective for you. He might give you SI injections, personally I would not have them done because they only end up causing more damage than it's worth in most patients. SI injections are not intended for the spine even thought doctors do this on a regular basis. The medical information sheet that comes with such medicines even clearly define what they can and can't be used for and back or sacrial (sp) joints are explicity stated as one of the joints were steriods should be injected to. Ultimately it's your decision if you wish to go ahead and decide to do them.
Once you find a good PM you need to understand a few things:
It is never the goal of a PM to give you 100% relief. Some believe that 50% is adequate, other's shoot for a little higher. Mine shoots for about 70% depending on type of pain. So it is something you must accept and go in realizing.
Pain management as a whole is not just about medications it involved many things and often times a good PM will require that you partake in many of the other treatments such as:
Pain management classes - often lasting 6 weeks or so you learn methods of physcial activity such as stretching, or water aquatics to help keep the joints limber and reduce pain. You also learn such techniques as biofeed back and focusing to help you through the moments of most difficult pain. They also give you advice on lifestyle changes. Some things inevitably make the pain worse, some of those are things we love, so basically they help you to come to grips with these issues. A psych. can also help you with that.
Psychological services - many times the do request you see a pschologist or psychiatrist who deals in pain management to learn how to cope emotionally with the pain as well as your loved ones. All pain patients as some point do get depressed, this is normal, it doesn't mean you need to be on antidepressants however. Unless you have severe depression or depression on a daily basis there's no need to be on such medications unless it is for sleeping. But it is important to accept your pain and deal with it appropriately.
Alternative therapies - some will reccomend a TENS unit to help mask pain, others might suggest physical therapy. There is a host of various alternative therapies that compliment the standard pain medications.
--- more ---
Kissa
08-15-2004, 09:39 PM
One you meet up with your PM you may discuss some of these various methods and if they use them or not. You will work together to come up with a plan of action on what to do next.
When you are prescribed medications as a general rule they start you on lower doses or meds of lesser strength and then work you up as needed. Sometimes it can take months, if not longer, to get you to the point that you have enough relief to be functional but again, you won't be at 100%.
I hope that answered some of your questions. I'm sure other's have advice to offer as well. I do strongly suggest you seek out a PM, or at the very least talk to your GP and ask about pain management classes, they could be benificial to you.
Best of luck
Barbie
When you are prescribed medications as a general rule they start you on lower doses or meds of lesser strength and then work you up as needed. Sometimes it can take months, if not longer, to get you to the point that you have enough relief to be functional but again, you won't be at 100%.
I hope that answered some of your questions. I'm sure other's have advice to offer as well. I do strongly suggest you seek out a PM, or at the very least talk to your GP and ask about pain management classes, they could be benificial to you.
Best of luck
Barbie
jajackson
08-16-2004, 12:20 AM
Thank you Barbie for all your info. I have been to pain management several times, most recently I was referred to PM by my doc, but because we're military my referral only consists of 4 visits, then he suggests a plan of action and gives it to my GP. So far I've see him 2x, the first time he gave me Zanaflex to try and sent me for an MRI. My 2nd visit was the results of the MRI, and that's when I found out I had another hern. disc in my neck. He suggested injection, but that was it. I'm going to call him tomorrow and find out if there are any other options, or if he can get me to someone that can do real pain management.
I do realize that I'll never be 100%, and I have good days and bad days. I just wish I could go back to the days when a 800 motrin helped me. My GP has me on Zoloft and just started Wellbutrin too. I don't think I want to be on them anymore. I was never given antidepress. for depression, just pain mgmt. And obviously they're not working.
I'm going to see about seeing someone else for PM, I'll probably have to go to the big army hospital 45 minutes away. My GP told me the military likes their family practice doc's to handle that, like they have the expertice. Well that's all for my venting. Thanks for your input. I'm doing the best I can.
Amy.
I do realize that I'll never be 100%, and I have good days and bad days. I just wish I could go back to the days when a 800 motrin helped me. My GP has me on Zoloft and just started Wellbutrin too. I don't think I want to be on them anymore. I was never given antidepress. for depression, just pain mgmt. And obviously they're not working.
I'm going to see about seeing someone else for PM, I'll probably have to go to the big army hospital 45 minutes away. My GP told me the military likes their family practice doc's to handle that, like they have the expertice. Well that's all for my venting. Thanks for your input. I'm doing the best I can.
Amy.
Kissa
08-16-2004, 10:45 AM
That's a bit of an unfortunate situation that you can't see a good PM.
What is making it more difficult is you can't see a PM like most folks can and your regular doctor obviously doesn't want to prescribe the medications you need. You may want to call the PM and explain the situation, maybe he knows of a better way to get you the medications. It might be a situation were you have to pay for the visit with him, which in the long run may be worth it. Hopefully your insurance will pay for any meds. He may also know of another general doctor who is willing to help you out. Honestly there's no need for you to suffer like you are.
As far as the neck goes, you can do physical therapy on it, if that fails and the pain becomes worse or you loose feeling in your arm/hand then you may have to go the surgical route. I've had it done before and had a lot of sucess with it, I know many folks as well who had lots of sucess but there's also some failure stories out there as well.
Injections are only short term, they don't help long term and can in fact cause more problems than it's worth. I'd tread cautiously on those.
Antidepressants alone for pain are not effective, generally they need coupled with pain medication. It sounds as though maybe you need a medication adjustment if what you are taking now isn't effective.
It still doesn't hurt to see if they will cover a pain management type course, at least to get you on the road to starting to deal with the pain more appropriately. It's definately better than nothing.
Let us know how it works out
What is making it more difficult is you can't see a PM like most folks can and your regular doctor obviously doesn't want to prescribe the medications you need. You may want to call the PM and explain the situation, maybe he knows of a better way to get you the medications. It might be a situation were you have to pay for the visit with him, which in the long run may be worth it. Hopefully your insurance will pay for any meds. He may also know of another general doctor who is willing to help you out. Honestly there's no need for you to suffer like you are.
As far as the neck goes, you can do physical therapy on it, if that fails and the pain becomes worse or you loose feeling in your arm/hand then you may have to go the surgical route. I've had it done before and had a lot of sucess with it, I know many folks as well who had lots of sucess but there's also some failure stories out there as well.
Injections are only short term, they don't help long term and can in fact cause more problems than it's worth. I'd tread cautiously on those.
Antidepressants alone for pain are not effective, generally they need coupled with pain medication. It sounds as though maybe you need a medication adjustment if what you are taking now isn't effective.
It still doesn't hurt to see if they will cover a pain management type course, at least to get you on the road to starting to deal with the pain more appropriately. It's definately better than nothing.
Let us know how it works out