Senior Veteran (male)
Join Date: Jun 2003
Re: I feel helpless! Doc won't give me anything for pain
Hi Mama, Actually, It's unlikely hat an Xray would show anything other than the changes that occur with age or compresion fractures from osteo perosis., They wont show disc bulges, nerve compressions , stenosis or anything other than the change in shape of vertabrea and the space between each one which indicates degenerative disc disease which everyone over the age of 30 suffers from to some extent. You may catch a bone spur, but if you have something major that requires surgery an Xray is just the beginning. The fact that you your pain isn't localized, meaning you have pain from your lower back to your neck, and your pain isn't constant is more indicicative or degeneration that takes place in all people over 30.
I'm not sure it would really be worth the money to do expensive nuclear testing if you can get buy on 10 vicodin a year. Your best bet is to simply go to your GP when your having a flair and let him treat it.
Shrinks simply don't treat pain unless they specialize in pain management. As John said, Clonazapam is the drug of choice for generalized anxiety along with antidepresants. It has the longest half life of all benzos, Up to 30 hours. The dose of Xanax you took is about 4 times stronger than taking a .5 mgg klonopin so I don't doubt it worked, It's just not the prefered drug to treat anxiety other than very short term situational anxiety, family member passed away, divorce, family illness etc . If the klonopin isn't working it is your job to tell your shrink and let him come up with a treatment plan.
Antidepressants also work on pain. In the days before OcyContin it was the staple med used to treat chronic pain. Just because they invented something much sronger and longer lasting in the way of opiates doesn't mean antidepressants no longer work. When you say nobody will give you pain meds, it really sounds like you have only asked your shrink and Rhuemy, neither of which are true pain managment docs unles they did an additional internship or fellowship in pain management or intervention. The problem with the shrink giving you pain meds is that it's hard to distinguish improvement from antidepressants when opiates alter your perception and mood. They give you a false sense of well being and don't treat the problem other than make you feel good.
The reason I suggest you treat it as needed with your GP is based on your present need. PM docs that use opiates put people on opiates round the clock 7 days a week and when you add dependence to opiates into your psych issues the water gets even mudier and the only time you would feel good is when you feel that false sense of well being. You should rule out anthing machanical with your spine but basd on your symptoms, It's not like it's a daily round the clock problem that a surgeon would address or treat other than to presceribe PT, which would be a good thing. AS we get older it's more and more important to excercise and remain strong and healthy. The absolute worst thing for anyones over all health is to become sedentary and PT will be a starting place to get you moving, learn to do excercise safely and the proper form for what you need.
That initial injury was more than likely a simple strain and once you weaken an area you become more prone to reinjur that same area, That's where PT and excercise come in. Surgeons treat surgical candidates, although I do reccomend seeing one just to rule out any possible issue . You may have something simple like a bone spur from arthritis which can now be delt with in a minimally invasive manner when it becomes so bothersome you can't function. Being cranky , angry along with bipolar isn't the same as having chronic debilitating pain. Their is a mind body conection and when your stressed, blood flow decreases and you become more suceptable pain, spasm or strain.
I jiust dont agree that you need to find a PM doc to give you month suplies of opiates and put up with all that's involved in PM. UA's, pill counts, contracts and all the other BS. The first time you have a pill count and go in and they find you only took 3 of the 60 pills he prescribed he will determine you dont need them. That's why it's more prudent to start with tier one meds you GP can supply as needed whether it's tramadol. Ultracet,tylenol 3 or couple vicodin to get you past the worst of it. The next time you have a flair up go to your GP.
It is not everyone right to have a big bottle of Vicodin or percocet in the medecine cabinet in every houshold in case you have a bad day.
Not to mention the depressant qualities of opiates will make your psych issues even more difficult to manage. You may have to decide what's more important, maintaing your regemin for bipolar or having pain meds readily available just in case you need them. Pain management isn't for just in case you need them 4 or 5 times a year.
Long term anxiety issues can be managed with anti D's and the benzo of choice is Clonazapam, you may simply need a slight increase or a change in antidepressant. You will also find that excercise helps depression and anxiety, so their isn't a simple answer like a large bottle of vicodin just in case you may need one a couple times a year. If you start using the pan meds to treat your anxiety and it would feel effective, your heading down a slippery slope. The fact you would take a med that's 4 times as potent as the one your on, a 2 mg Xanax without any clue of the potential side efects or harm isn't condusive to pain management. PM is all about compliance, Their shoud be no self medication or adjusting of ones dose by the patient. The first time you do that would likely be the last time you are prescribed anything like Vicodin for pain.
Be greatful you only have to deal with your pain on an as needed basis. Everyone of us on long term opiate therapy for pain also deals with physcial dependence, the potential for ever growing tolerance and in the present atmospher of wide spread abuse of these meds, You need a real reason to justify using these meds other than on an as needed basis. The dea will never question your GP for prescribing a handful of pain meds and a couple muscle relaxers a few time a year. Where PM docs are under enormous scrutiny to justify the use in every patient or risk loosing their licence and the ability to treat those who truly can't function day to day with out them. If you sraiin your back again, go see your GP, If the standard medical model doesn't help you which includes short term use of meds and PT, then you move on to more comprehensive and expensive diagnostics
When you go see a surgeon he's going to ask what part of your back hurts the most, telling him your entire spine isn't something that can be surgically fixed. Their are modalities that can help but opiates and surgery aren't the only answer unless you simply can't function and can no longer take the day in and out pain where it effects all aspects of your life from sleep to intamcy, BP and the ability to work and hold a job. Although the psych issues may intefere with these things, you need to seperate the psych from the physical and understand that if you having a bad day emotionally, your more than likely going to experience it physcialy in some way. Be more open with you shrink and forget about him treating pain flair ups, That's simply not his job, That's what your GP is for. I get pain thats makes you knees buckle but that's doesn't mean you have a nerve compression or a spinal cord compression or anything a surgeon can fix. Once a surgeon realizes you not a candidate for surgery it pretty much ends your relationship with him.
I do like the idea of an Internist simply because it's one doc that coordidinates all your care and looks at the possible links betwen one problem and another. I have so many specialist I can't remeber the last time I went to see my GP other than for a pre surgical physcial. They do have their place for sprained ankles, strep throat, and occasional muscle strains , but that's about the extent of their specialized training or knowledge.
It sounds like more of a case of the straw that breaks the camels back when you back is acting up in addition to your other issues and that's no reason to get involved in pain management other than for alternative therapies to opiates. Has you shrink tought you any relaxation therapies for your anxiety? Bio feedback, self hypnsosis, breathing excercises, or guided imagry? The same things that work for anxiety can also get you through a flair or an uncomfortable evening. You also may benefit from chirpractic. a Vertabrea slipping out of place due to poor muscle tone can cause those same symptoms and can be treated by a chiro or an Osteopath.
Good luck, Dave
Last edited by Shoreline; 03-10-2012 at 08:55 PM.